1881657294 NPI number — ARVIND V PEDDADA MD PA

Table of content: (NPI 1881657294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881657294 NPI number — ARVIND V PEDDADA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARVIND V PEDDADA MD PA
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:
1881657294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-284-9850
Provider Business Mailing Address Fax Number:
817-284-3425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 W US HIGHWAY 82
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-7069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-284-9850
Provider Business Practice Location Address Fax Number:
817-720-9892
Provider Enumeration Date:
04/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEDDADA
Authorized Official First Name:
ARVIND
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-284-9850

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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