1821340415 NPI number — PATRICK G DUFFY DDS, MD INC

Table of content: (NPI 1821340415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821340415 NPI number — PATRICK G DUFFY DDS, MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK G DUFFY DDS, MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1821340415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 EDGEWOOD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
451-640-8595
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2147 MOWRY AVE
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-574-1868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DUFFY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
GILES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
415-640-8595

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  59005 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1639174667 . This is a "OTHER NPI NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com