1932307691 NPI number — DR. DIPEN KADARIA MD

Table of content: DR. DIPEN KADARIA MD (NPI 1932307691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932307691 NPI number — DR. DIPEN KADARIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KADARIA
Provider First Name:
DIPEN
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:
1932307691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
DEPT # 457
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-758-7888
Provider Business Mailing Address Fax Number:
901-387-5153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 EASTMORELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-758-7888
Provider Business Practice Location Address Fax Number:
901-387-5153
Provider Enumeration Date:
07/04/2007

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: 207RC0200X , with the licence number:  49612 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: DR.0058033 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 49612 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01289042 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 198151001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4355725 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 029310 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: Q002087 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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