1447254800 NPI number — DR. SANDEEP BAJAJ M.D.

Table of content: DR. SANDEEP BAJAJ M.D. (NPI 1447254800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447254800 NPI number — DR. SANDEEP BAJAJ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAJAJ
Provider First Name:
SANDEEP
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1447254800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
483 N SEMORAN BLVD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-645-1847
Provider Business Mailing Address Fax Number:
321-274-0246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 N SEMORAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-645-1847
Provider Business Practice Location Address Fax Number:
321-274-0246
Provider Enumeration Date:
06/13/2005

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: 207RC0000X , with the licence number:  ME64582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: ME64582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2171130012 . This is a "CIGNA PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 373499400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12650 . This is a "FHHS PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 196550 . This is a "STAYWELL MCD PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 196550 . This is a "HEALTHESE MCD PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 208683 . This is a "AMERIGROUP MCD PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 196550 . This is a "WELLCARE PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 386222 . This is a "HUMANA PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1090291 . This is a "UNITED H'CARE PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 23141 . This is a "BCBS OF FL PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060039486 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 72852 . This is a "FIRST HEALTH PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273066 . This is a "GREAT WEST PROV ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4411299 . This is a "AETNA PRO ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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