1801851183 NPI number — PADMINI V HOLLA MD

Table of content: PADMINI V HOLLA MD (NPI 1801851183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801851183 NPI number — PADMINI V HOLLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLA
Provider First Name:
PADMINI
Provider Middle Name:
V
Provider Name Prefix Text:
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:
1801851183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1849
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04241-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-784-2554
Provider Business Mailing Address Fax Number:
207-777-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 WHITEHALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-332-7303
Provider Business Practice Location Address Fax Number:
603-330-0098
Provider Enumeration Date:
04/19/2006

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: 207ZP0105X , with the licence number:  48215 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 13747 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: 017678 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30207356 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2145316 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".