1922279124 NPI number — EMILIA DULGHERU RHEUMATOLOGY LLC

Table of content: (NPI 1922279124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922279124 NPI number — EMILIA DULGHERU RHEUMATOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMILIA DULGHERU RHEUMATOLOGY LLC
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:
1922279124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63902-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-686-1144
Provider Business Mailing Address Fax Number:
573-686-0178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 LUCY LEE PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-1144
Provider Business Practice Location Address Fax Number:
573-686-3312
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DULGHERU
Authorized Official First Name:
EMILIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
573-686-1144

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  2006029612 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1407850100 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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