1255449906 NPI number — HOSAHALLY NAGARAJ M.D.

Table of content: HOSAHALLY NAGARAJ M.D. (NPI 1255449906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255449906 NPI number — HOSAHALLY NAGARAJ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGARAJ
Provider First Name:
HOSAHALLY
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:
1255449906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 617
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERTON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85350-0617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-315-7910
Provider Business Mailing Address Fax Number:
928-722-6113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 S OAK AVE STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85336-0756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-662-0409
Provider Business Practice Location Address Fax Number:
928-722-6113
Provider Enumeration Date:
08/25/2006

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: 207L00000X , with the licence number:  187428 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01269772 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10001449 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000410983001 . This is a "BSNENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2600296 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 187428-8CAN . This is a "WC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5765306 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 05277 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12G281 . This is a "EMPIRE BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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