1497953319 NPI number — MRS. RADHIKA PRIYA IPPATOORI MSPT

Table of content: MRS. RADHIKA PRIYA IPPATOORI MSPT (NPI 1497953319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497953319 NPI number — MRS. RADHIKA PRIYA IPPATOORI MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IPPATOORI
Provider First Name:
RADHIKA
Provider Middle Name:
PRIYA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1497953319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7650 EAST PARHAM ROAD
Provider Second Line Business Mailing Address:
MOB II SUIT 120
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-545-4952
Provider Business Mailing Address Fax Number:
804-545-4952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7650 E PARHAM RD
Provider Second Line Business Practice Location Address:
MOB II SUITE 120;PARHAM DOCTORS-SORC
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23294-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-545-4952
Provider Business Practice Location Address Fax Number:
804-545-4952
Provider Enumeration Date:
07/03/2007

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:  2305204530 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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