1659517670 NPI number — DR. PRADEEP KRISHNAN NAIR M.D.

Table of content: DR. PRADEEP KRISHNAN NAIR M.D. (NPI 1659517670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659517670 NPI number — DR. PRADEEP KRISHNAN NAIR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAIR
Provider First Name:
PRADEEP
Provider Middle Name:
KRISHNAN
Provider Name Prefix Text:
DR.
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:
1659517670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUMA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70361-4176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-876-0300
Provider Business Mailing Address Fax Number:
985-872-0317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 DUNN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUMA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70360-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-876-0300
Provider Business Practice Location Address Fax Number:
985-872-0317
Provider Enumeration Date:
12/22/2008

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:  MD432572 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 207595 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2382438 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com