1740250018 NPI number — DR. JAY LAWRENCE DINERMAN M.D.

Table of content: (NPI 1801093752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740250018 NPI number — DR. JAY LAWRENCE DINERMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINERMAN
Provider First Name:
JAY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
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:
1740250018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 FRANKLIN ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-4080
Provider Business Mailing Address Fax Number:
256-539-4099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 FRANKLIN ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-4080
Provider Business Practice Location Address Fax Number:
256-539-4099
Provider Enumeration Date:
01/26/2006

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: 207RC0000X , with the licence number:  23742 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 23742 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112284 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112292 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-49220 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051500185 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3335705 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-99674 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00747425 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060061475 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4011927 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 51000185 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 112282 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112287 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-49219 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-99672 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-99673 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 25-00014 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4583857 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510-49218 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 112290 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112295 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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