1427099654 NPI number — PRASAD S MATURU MD

Table of content: PRASAD S MATURU MD (NPI 1427099654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427099654 NPI number — PRASAD S MATURU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATURU
Provider First Name:
PRASAD
Provider Middle Name:
S
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:
1427099654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
# L-3652
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43260-6453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-383-7927
Provider Business Mailing Address Fax Number:
740-383-7942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 DELAWARE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43301-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-383-7920
Provider Business Practice Location Address Fax Number:
740-383-7942
Provider Enumeration Date:
06/09/2006

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:  35053451M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 35053451M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 643272 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0633470 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311098079037 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100004717 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2900073 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311098079 . This is a "PPO NEXT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000118385 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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