1922285147 NPI number — VAFA FERDOWSIAN DPM, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922285147 NPI number — VAFA FERDOWSIAN DPM, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VAFA FERDOWSIAN DPM, P.A.
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:
6
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:
1922285147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10607
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72034-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-327-3668
Provider Business Mailing Address Fax Number:
501-327-3664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 HOGAN LN STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-8216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-327-3668
Provider Business Practice Location Address Fax Number:
501-327-3664
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FERDOWSIAN
Authorized Official First Name:
VAFA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
501-327-3668

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 230 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05080020101 . This is a "QUALCHOICE INDIVIDUAL NUM" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 201228716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156810717 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00304134 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 163819748 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5764142 . This is a "CIGNA INDIVIDUAL NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5N327 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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