1831350016 NPI number — SAIMAH TALUKDER MD

Table of content: SAIMAH TALUKDER MD (NPI 1831350016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831350016 NPI number — SAIMAH TALUKDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALUKDER
Provider First Name:
SAIMAH
Provider Middle Name:
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:
HUSSAIN
Provider Other First Name:
SAIMAH
Provider Other Middle Name:
TALUKDER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831350016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 FAIRFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71101-4443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-681-7728
Provider Business Mailing Address Fax Number:
318-681-7729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 FAIRFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-4443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-681-7728
Provider Business Practice Location Address Fax Number:
318-681-7729
Provider Enumeration Date:
06/20/2008

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: 207VX0000X , with the licence number:  MD.202866 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: MD.202866 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1802646 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: TRAINING . This is a "DC TRAINING LICENSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0116016478 . This is a "VA RESIDENT LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 179700001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207280301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD.202866 . This is a "LOUISIANA STATE BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: TRAINING . This is a "MD TEMPORARY RESIDENT LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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