1134101413 NPI number — MEHRDAD BEHNIA MD

Table of content: MEHRDAD BEHNIA MD (NPI 1134101413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134101413 NPI number — MEHRDAD BEHNIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHNIA
Provider First Name:
MEHRDAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1134101413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 N ORANGE AVE STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32804-4644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-303-7283
Provider Business Mailing Address Fax Number:
407-303-0347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E ROLLINS ST
Provider Second Line Business Practice Location Address:
CRITICAL CARE SPECIALISTS
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-303-7283
Provider Business Practice Location Address Fax Number:
407-303-0347
Provider Enumeration Date:
11/14/2005

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: 207RP1001X , with the licence number:  049611 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 049611 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: ME127385 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: ME127385 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: G49611 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000895111D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000895111F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134101413 . This is a "NPI NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 018407500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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