1700870722 NPI number — GEORGIA K DORULLA MD

Table of content: GEORGIA K DORULLA MD (NPI 1700870722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700870722 NPI number — GEORGIA K DORULLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORULLA
Provider First Name:
GEORGIA
Provider Middle Name:
K
Provider Name Prefix Text:
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:
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:
1700870722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 ALBANY ST
Provider Second Line Business Mailing Address:
SUITE 906
Provider Business Mailing Address City Name:
BEECH GROVE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46107-1557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-787-3296
Provider Business Mailing Address Fax Number:
317-783-4107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 ALBANY ST
Provider Second Line Business Practice Location Address:
SUITE 906
Provider Business Practice Location Address City Name:
BEECH GROVE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46107-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-787-3296
Provider Business Practice Location Address Fax Number:
317-783-4107
Provider Enumeration Date:
09/06/2005

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: 2085R0202X , with the licence number:  1042298 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00032566 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00408569 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00033126 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00033113 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00033114 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032765 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00033093 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000109950 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00032884 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032561 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032996 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00032995 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00033075 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".