Provider Demographics
NPI:1801095948
Name:ALLERGY AND ASTHMA CENTER OF CAPE COD
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER OF CAPE COD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SKLAREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-362-0099
Mailing Address - Street 1:244 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1757
Mailing Address - Country:US
Mailing Address - Phone:508-362-0099
Mailing Address - Fax:
Practice Address - Street 1:244 WILLOW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1757
Practice Address - Country:US
Practice Address - Phone:508-362-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3126935Medicaid
MAF79779Medicare UPIN