1821195355 NPI number — DR. PAPARAO ADUSUMILLI M.D.

Table of content: DR. PAPARAO ADUSUMILLI M.D. (NPI 1821195355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821195355 NPI number — DR. PAPARAO ADUSUMILLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADUSUMILLI
Provider First Name:
PAPARAO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADUSUMILLI
Provider Other First Name:
P
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821195355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2010 RANCHO LAKE DR UNIT 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89108-6477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-653-2112
Provider Business Mailing Address Fax Number:
702-653-2832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 LAS VEGAS BLVD N
Provider Second Line Business Practice Location Address:
NELLIS AFB.FEDERAL HOSPITAL.RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
NELLIS AFB
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89191-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-653-2112
Provider Business Practice Location Address Fax Number:
702-653-2832
Provider Enumeration Date:
09/19/2006

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: 174400000X , with the licence number:  F8787 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00TY946 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".