1871682260 NPI number — DR. PRABHAKARA SOMAYAJI MD

Table of content: DR. PRABHAKARA SOMAYAJI MD (NPI 1871682260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871682260 NPI number — DR. PRABHAKARA SOMAYAJI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMAYAJI
Provider First Name:
PRABHAKARA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1871682260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
549 4TH ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14301-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-285-0853
Provider Business Mailing Address Fax Number:
716-284-2034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
549 4TH ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14301-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-285-0853
Provider Business Practice Location Address Fax Number:
716-284-2034
Provider Enumeration Date:
10/12/2006

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:  142353-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 142353 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0032916 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426003520 . This is a "FIDELAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1901029 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00624828 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00010170301 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000508061001 . This is a "BLUE CROSS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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