1821099698 NPI number — MARK A PLUNKETT MD

Table of content: MARK A PLUNKETT MD (NPI 1821099698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821099698 NPI number — MARK A PLUNKETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUNKETT
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1821099698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5011 BURNET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78756-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-583-2020
Provider Business Mailing Address Fax Number:
512-744-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5011 BURNET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78756-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-583-2020
Provider Business Practice Location Address Fax Number:
512-744-2020
Provider Enumeration Date:
08/03/2005

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: 207W00000X , with the licence number:  J2258 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4118033 . This is a "BLUE LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5671185 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8M5282 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00127589 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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