1497756506 NPI number — SHASHIKALA A GOGATE MD

Table of content: SHASHIKALA A GOGATE MD (NPI 1497756506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497756506 NPI number — SHASHIKALA A GOGATE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOGATE
Provider First Name:
SHASHIKALA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1497756506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-687-5164
Provider Business Mailing Address Fax Number:
740-654-1417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N EWING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-3372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-687-8141
Provider Business Practice Location Address Fax Number:
740-687-8973
Provider Enumeration Date:
08/10/2005

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: 207ZP0102X , with the licence number:  35034871 , 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: 0531044 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".