1902992530 NPI number — RICHARD H CIORDIA MD

Table of content: RICHARD H CIORDIA MD (NPI 1902992530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902992530 NPI number — RICHARD H CIORDIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIORDIA
Provider First Name:
RICHARD
Provider Middle Name:
H
Provider Name Prefix Text:
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:
1902992530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 BAYOU BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-477-8109
Provider Business Mailing Address Fax Number:
850-478-2412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4810 NORTH DAVIS HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-474-8988
Provider Business Practice Location Address Fax Number:
850-476-5312
Provider Enumeration Date:
10/04/2006

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: 207L00000X , with the licence number:  ME20564 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000285430005 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9896 . This is a "HEALTH OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5288611 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00227582 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17329 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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