1851377196 NPI number — MRIDU S CHAND MD

Table of content: BRIANNA ZIMMER (NPI 1861104804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851377196 NPI number — MRIDU S CHAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAND
Provider First Name:
MRIDU
Provider Middle Name:
S
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:
1851377196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 117287
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-7287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-274-8200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
551 BREVARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28806-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-212-7021
Provider Business Practice Location Address Fax Number:
828-232-8218
Provider Enumeration Date:
12/19/2005

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: 207RH0000X , with the licence number:  200201057 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 200201057 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 200201057 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D6225 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2029225B . This is a "MEDICARE - SYLVA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2029225C . This is a "MEDICARE -- BREVARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89137HW , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2029225A . This is a "MEDICARE - ASHEVILLE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P00430819 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 137HW . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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