1457365744 NPI number — MRS. KRISNA NIKKA RECOMETA COLBURN M.P.T.

Table of content: MRS. KRISNA NIKKA RECOMETA COLBURN M.P.T. (NPI 1457365744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457365744 NPI number — MRS. KRISNA NIKKA RECOMETA COLBURN M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLBURN
Provider First Name:
KRISNA NIKKA
Provider Middle Name:
RECOMETA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RECOMETA
Provider Other First Name:
KRISNA
Provider Other Middle Name:
NIKKA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457365744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8600 SNOWDEN RIVER PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-1982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-720-5555
Provider Business Mailing Address Fax Number:
410-381-4653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8600 SNOWDEN RIVER PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-1982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-720-5555
Provider Business Practice Location Address Fax Number:
410-381-4653
Provider Enumeration Date:
07/29/2006

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: 225100000X , with the licence number:  19998 , 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: 2275307 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 610334-05 . This is a "BLUECROSS BLUESHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T6710016 . This is a "BLUECROSS BLUESHIELD DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 147433401 . This is a "ACS / US DEPT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2470862 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5552701 . This is a "CCN NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 684017 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2128468 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 57731 . This is a "JOHN HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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