1780682575 NPI number — DR. KALPANA S. DESHMUKH MD

Table of content: DR. KALPANA S. DESHMUKH MD (NPI 1780682575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780682575 NPI number — DR. KALPANA S. DESHMUKH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESHMUKH
Provider First Name:
KALPANA
Provider Middle Name:
S.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1780682575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1710
Provider Second Line Business Mailing Address:
SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-770-0504
Provider Business Mailing Address Fax Number:
856-770-0395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2776 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-5864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-343-2000
Provider Business Practice Location Address Fax Number:
856-751-0535
Provider Enumeration Date:
07/14/2005

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: 2085R0202X , with the licence number:  25MA04036100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME125789 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101809000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10654859 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2100749 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300122630 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1188704 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63402 . This is a "PREMIER BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1144632 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2608168 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0057263000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063402 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 63402 . This is a "HIGHMARK PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: MRZ7W . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: A3738029 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: KP347 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101809000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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