1134370786 NPI number — YASHASH PATHAK M.D.

Table of content: YASHASH PATHAK M.D. (NPI 1134370786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134370786 NPI number — YASHASH PATHAK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATHAK
Provider First Name:
YASHASH
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:
1134370786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16605 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-0003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-777-5334
Provider Business Mailing Address Fax Number:
713-429-5207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16605 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-777-5334
Provider Business Practice Location Address Fax Number:
713-429-5207
Provider Enumeration Date:
10/01/2008

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: 207R00000X , with the licence number:  P9688 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: P9688 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P01362982 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8EV375 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 342257801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 367026YT8B . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com