1043548019 NPI number — V. RAJA CHANDRA, MD PC

Table of content: MR. JEFFERY LANE ULMER P.A.-C. (NPI 1225072614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043548019 NPI number — V. RAJA CHANDRA, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
V. RAJA CHANDRA, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043548019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 8TH ST
Provider Second Line Business Mailing Address:
PO BOX 1768
Provider Business Mailing Address City Name:
RAWLINS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82301-5460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-324-2294
Provider Business Mailing Address Fax Number:
307-328-1964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAWLINS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82301-5460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-324-2294
Provider Business Practice Location Address Fax Number:
307-328-1964
Provider Enumeration Date:
12/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHANDRASEKARAN
Authorized Official First Name:
VENKATAPERUMAL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-324-2294

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  2812A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 760011087 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 00072001 . This is a "BCBS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 106489400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".