1528000890 NPI number — MS. PUSHPA R MUDAN MD

Table of content: MS. PUSHPA R MUDAN MD (NPI 1528000890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528000890 NPI number — MS. PUSHPA R MUDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUDAN
Provider First Name:
PUSHPA
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RANGANATHAN
Provider Other First Name:
PUSHPAVALLI
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528000890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-821-7788
Provider Business Mailing Address Fax Number:
603-821-5620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-821-7788
Provider Business Practice Location Address Fax Number:
603-821-5620
Provider Enumeration Date:
06/12/2006

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: 207P00000X , with the licence number:  48483 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 14664 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110006287/A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7051466 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1528000890 . This is a "ANTHEM BCBS NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30209531 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00892397 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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