1275500712 NPI number — DR. SANDRA D DAYARATNA MD

Table of content: DR. SANDRA D DAYARATNA MD (NPI 1275500712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275500712 NPI number — DR. SANDRA D DAYARATNA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAYARATNA
Provider First Name:
SANDRA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
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:
1275500712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 CHESTNUT STREET
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-4420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-955-5000
Provider Business Mailing Address Fax Number:
215-923-1089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-4420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-5000
Provider Business Practice Location Address Fax Number:
215-923-1089
Provider Enumeration Date:
03/03/2006

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: 207V00000X , with the licence number:  206983 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 35-088723 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD437090 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 206983 . This is a "MA LICENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00422677 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000221069 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7400041 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000509157 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 51020 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7228135 . This is a "AETNA NON HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7228135 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 740798 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: J22704 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1895243 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 206983 . This is a "MEDICARE PREFERRED/TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2703873 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9676427001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2339545 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 414958 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: J22704 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".




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