1982852190 NPI number — DR. TRICIA L KALWAR MD

Table of content: DR. TRICIA L KALWAR MD (NPI 1982852190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982852190 NPI number — DR. TRICIA L KALWAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALWAR
Provider First Name:
TRICIA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
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:
1982852190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 SE 3RD AVE
Provider Second Line Business Mailing Address:
THIRD FLOOR PBO
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33316-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-355-4975
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 SE 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 525
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-847-4273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2008

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: 207RH0003X , with the licence number:  256988 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 52215 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: ME117962 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C02844 . This is a "MEDICARE GROUP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 015266300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".