1083659338 NPI number — MOHAMMAD KARBASSI M.D.

Table of content: MOHAMMAD KARBASSI M.D. (NPI 1083659338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083659338 NPI number — MOHAMMAD KARBASSI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARBASSI
Provider First Name:
MOHAMMAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1083659338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80501-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-772-3611
Provider Business Mailing Address Fax Number:
303-772-3609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-772-3611
Provider Business Practice Location Address Fax Number:
303-772-3609
Provider Enumeration Date:
06/19/2006

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:  44707 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KAM4707 . This is a "ANTHEM BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 931468 . This is a "EYE SPECIALISTS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 5476659 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 841353910 . This is a "TOTAL LONG TERM CARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: SS#841353910 . This is a "VSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44707 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841353910002 . This is a "ROCKY MOUNTAIN HMO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com