1487655692 NPI number — SENTHIL K NATARAJAN M.D.

Table of content: SENTHIL K NATARAJAN M.D. (NPI 1487655692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487655692 NPI number — SENTHIL K NATARAJAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATARAJAN
Provider First Name:
SENTHIL
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1487655692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1870 WINTON RD S
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-3960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-442-4690
Provider Business Mailing Address Fax Number:
585-442-4692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1870 WINTON RD S
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-3960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-442-4690
Provider Business Practice Location Address Fax Number:
585-442-4692
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  212672 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X , with the licence number: 212672 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7111484 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2911 . This is a "EXCELLUS BSH PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010212672 . This is a "BLUE CHOICE PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2199567 . This is a "GHI PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02523664 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: MDH755 . This is a "PREFERRED CARE PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00179341 . This is a "RAILROAD MEDICARE PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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