1871598649 NPI number — DR. MAHESH NARAYAN KABADI M.D.

Table of content: DR. MAHESH NARAYAN KABADI M.D. (NPI 1871598649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871598649 NPI number — DR. MAHESH NARAYAN KABADI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KABADI
Provider First Name:
MAHESH
Provider Middle Name:
NARAYAN
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:
KABADI
Provider Other First Name:
MAHESH
Provider Other Middle Name:
NARAYAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871598649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79 WEBER FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360-5236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-889-8950
Provider Business Mailing Address Fax Number:
860-887-1657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 CASE ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-889-8950
Provider Business Practice Location Address Fax Number:
860-887-1657
Provider Enumeration Date:
06/16/2005

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: 207RN0300X , with the licence number:  026236 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NLP016 . This is a "OXFORD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 6570931000 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010026236CT01 . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 01026236 . This is a "CIGNA ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 262360 . This is a "CONNECTICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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