1538456322 NPI number — DR. VINAYAK SREENIVAS GOWDA MD, MRCS,

Table of content: (NPI 1992936728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538456322 NPI number — DR. VINAYAK SREENIVAS GOWDA MD, MRCS,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOWDA
Provider First Name:
VINAYAK
Provider Middle Name:
SREENIVAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MRCS,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SREENIVAS
Provider Other First Name:
VINAYAK
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MRCS,
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538456322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1276 FULTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10456-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-992-7669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 SELWYN AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SURGERY, 4TH FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-7626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-960-1216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2011

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: 208600000X , with the licence number:  295882 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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