C.M.R. 90, 590, ch. 280, app 590-280-A
Current through 2024-51, December 18, 2024
| Data Element Name | Type | Maximum Length |
| DEA Number | Text | 9 |
| License Number | Text | 30 |
| NPI Number | Number | 10 |
| First Name | Text | 50 |
| Middle Name | Text | 50 |
| Last Name | Text | 50 |
| Suffix | Text | 6 |
| Degree or Credential | Text | 50 |
| Professional Specialty | Text | 100 |
| Practice Name | Text | 100 |
| Practice Physical Street 1 | Text | 100 |
| Practice Physical Street 2 | Text | 100 |
| Practice Physical Street 3 | Text | 100 |
| Practice Physical City | Text | 100 |
| Practice Physical State | Text | 2 |
| Practice Physical ZIP | Text | 9 |
| Practice Mailing Street 1 | Text | 100 |
| Practice Mailing Street 2 | Text | 100 |
| Practice Mailing Street 3 | Text | 100 |
| Practice Mailing City | Text | 100 |
| Practice Mailing State | Text | 2 |
| Practice Mailing ZIP | Text | 9 |
C.M.R. 90, 590, ch. 280, app 590-280-A