1437176880 NPI number — DEEPA VELAYADIKOT M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437176880 NPI number — DEEPA VELAYADIKOT M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

VELAYADIKOT

Provider First Name:

DEEPA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1437176880

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/20/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 FEDERAL ST # 200

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CAMDEN

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08103-1088

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-356-4924

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1 COOPER PLZ

Provider Second Line Business Practice Location Address:

THE COOPER HOSPITALIST TEAM

Provider Business Practice Location Address City Name:

CAMDEN

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08103-1461

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-342-3150

Provider Business Practice Location Address Fax Number:

856-968-8418

Provider Enumeration Date:

07/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  25MA07155100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: 25MA07155100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: P3737072 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 1352655 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1104234 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2165652 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 3K6200 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: P00400176 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 01000542001 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 41071 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 1448496 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2045126000 . This is a "AMERIHEALTH HMO, PPO, KEYSTONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 8533008 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".