1124283544 NPI number — CHITRA KUTHIALA MD PA

Table of content: (NPI 1124283544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124283544 NPI number — CHITRA KUTHIALA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHITRA KUTHIALA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1124283544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9765 SAN JOSE BLVD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32257-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-262-9135
Provider Business Mailing Address Fax Number:
904-880-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9765 SAN JOSE BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32257-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-262-9135
Provider Business Practice Location Address Fax Number:
904-880-2948
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KUTHIALA
Authorized Official First Name:
CHITRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-262-9135

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  ME29708 , 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: 192665 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 192665 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265658200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42736 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2699245 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3464796-01 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 279638 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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