1831184407 NPI number — DR. MARWAN KASKAS MD

Table of content: DR. MARWAN KASKAS MD (NPI 1831184407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831184407 NPI number — DR. MARWAN KASKAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASKAS
Provider First Name:
MARWAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1831184407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 BUCKNER ST
Provider Second Line Business Mailing Address:
SUITE C120
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71101-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-227-8899
Provider Business Mailing Address Fax Number:
318-222-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 GREENWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-631-1584
Provider Business Practice Location Address Fax Number:
318-635-8322
Provider Enumeration Date:
09/20/2005

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: 207RN0300X , with the licence number:  09084R , 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: 390005504 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 721404303KA1 . This is a "OCHSNER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106981702 . This is a "TEXAS MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1932469 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3100063 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A004 . This is a "CHAMPUS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com