1780828095 NPI number — DR. ARASH GHASSEMI PASHA MD

Table of content: DR. ARASH GHASSEMI PASHA MD (NPI 1780828095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780828095 NPI number — DR. ARASH GHASSEMI PASHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASHA
Provider First Name:
ARASH
Provider Middle Name:
GHASSEMI
Provider Name Prefix Text:
DR.
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:
1780828095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7075 N US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
PORT ST JOHN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32927-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-268-6264
Provider Business Mailing Address Fax Number:
321-268-6360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
PARRISH MEDICAL CENTER. HOSPITALIST DEPT
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32796-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-268-6111
Provider Business Practice Location Address Fax Number:
321-268-6360
Provider Enumeration Date:
04/30/2009

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: 207R00000X , with the licence number:  MD446234 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: ME118166 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: ME118166 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ATN 560202 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012488900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com