1760751531 NPI number — DR. GRACIELA SILVIA SIRONICH-KALKAN M.D.

Table of content: DR. GRACIELA SILVIA SIRONICH-KALKAN M.D. (NPI 1760751531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760751531 NPI number — DR. GRACIELA SILVIA SIRONICH-KALKAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRONICH-KALKAN
Provider First Name:
GRACIELA
Provider Middle Name:
SILVIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1760751531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
765 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03102-5141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-625-1724
Provider Business Mailing Address Fax Number:
603-625-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03102-5141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-625-1724
Provider Business Practice Location Address Fax Number:
603-625-1230
Provider Enumeration Date:
12/22/2011

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: 208D00000X , with the licence number:  15553 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3074421 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9393697 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05861844 . This is a "ECFMG" identifier . This identifiers is of the category "OTHER".