1912988171 NPI number — ENKELEJDA PLASA M.D.

Table of content: ENKELEJDA PLASA M.D. (NPI 1912988171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912988171 NPI number — ENKELEJDA PLASA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLASA
Provider First Name:
ENKELEJDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAKO
Provider Other First Name:
ENKELEJDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912988171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24651 CENTER RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-895-5056
Provider Business Mailing Address Fax Number:
440-333-2935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25200 CENTER RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-331-3356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2005

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: 207R00000X , with the licence number:  35-083943 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2514550 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000342373 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9322131 . This is a "GROUP MEDICARE PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0119204 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9273172 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000328291 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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