1104803535 NPI number — NOHA SADEK MD

Table of content: NOHA SADEK MD (NPI 1104803535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104803535 NPI number — NOHA SADEK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADEK
Provider First Name:
NOHA
Provider Middle Name:
Provider Name Prefix Text:
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:
1104803535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 VETERANS MEMORIAL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02915-5061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-432-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 VETERANS MEMORIAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02915-5061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-432-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005

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: 2084P0800X , with the licence number:  230510 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP35437 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 072M1SA , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH9041030861 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 142054 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1621116 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 552539 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63377100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7764 . This is a "AVERA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 072M1SA . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A058 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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