1780706820 NPI number — PRASHANTH PARAMESH SANTHEKADUR MD

Table of content: PRASHANTH PARAMESH SANTHEKADUR MD (NPI 1780706820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780706820 NPI number — PRASHANTH PARAMESH SANTHEKADUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTHEKADUR
Provider First Name:
PRASHANTH
Provider Middle Name:
PARAMESH
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:
1780706820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2377
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21041-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-884-1311
Provider Business Mailing Address Fax Number:
410-884-6033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11055 LITTLE PATUXENT PKWY
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-2896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-884-1311
Provider Business Practice Location Address Fax Number:
410-884-6033
Provider Enumeration Date:
04/06/2007

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: 207RI0200X , with the licence number:  D0066350 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 402077400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: G972 . This is a "BLUE CHOICE , FEP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KES7IN . This is a "CAREFIRST MARYLAND GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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