1497786701 NPI number — ALDO A BUONANNO M.D.

Table of content: TERRY CRAVEN WOOD (NPI 1871155143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497786701 NPI number — ALDO A BUONANNO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUONANNO
Provider First Name:
ALDO
Provider Middle Name:
A
Provider Name Prefix Text:
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:
1497786701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3925 ABBOTSFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46074-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-446-9394
Provider Business Mailing Address Fax Number:
765-447-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3660 ROME DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-4488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-446-9394
Provider Business Practice Location Address Fax Number:
765-447-8875
Provider Enumeration Date:
07/05/2006

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: 2084P0800X , with the licence number:  01029713 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100189010B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com