1770522294 NPI number — MARK DROGIN MD

Table of content: NIDHI TALPADE PT, DPT (NPI 1588303994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770522294 NPI number — MARK DROGIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DROGIN
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1770522294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 957
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78294-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-491-4300
Provider Business Mailing Address Fax Number:
210-495-1029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23445 US HIGHWAY 281 N
Provider Second Line Business Practice Location Address:
BUILDING 2
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-7317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-491-4300
Provider Business Practice Location Address Fax Number:
210-495-1029
Provider Enumeration Date:
06/06/2006

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: 207Q00000X , with the licence number:  F9380 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: F9380 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00076MY . This is a "BCBS GROUP#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8V4340 . This is a "BCBS INDIVIDUAL #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".