1275587396 NPI number — SUHAS MADHIRAJU MD

Table of content: SUHAS MADHIRAJU MD (NPI 1275587396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275587396 NPI number — SUHAS MADHIRAJU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADHIRAJU
Provider First Name:
SUHAS
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:
1275587396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 BALLARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLE RIVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21220-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-686-3931
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 BALLARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLE RIVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21220-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-686-3931
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006

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: 207R00000X , with the licence number:  D0057250 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KCE8 61607001 . This is a "CAREFIRST BC-BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S189 / 0036 . This is a "BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KF68 / 616070-02 . This is a "BC / BS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R103-002 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 798501100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com