1952487787 NPI number — DR. PALANISAMY RATHINASAMY MD

Table of content: DR. PALANISAMY RATHINASAMY MD (NPI 1952487787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952487787 NPI number — DR. PALANISAMY RATHINASAMY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATHINASAMY
Provider First Name:
PALANISAMY
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:
1952487787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 S.MOON AVE, SUITE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-5716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-681-4644
Provider Business Mailing Address Fax Number:
813-654-4486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 S.MOON AVE, SUITE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-681-4644
Provider Business Practice Location Address Fax Number:
813-654-4486
Provider Enumeration Date:
10/27/2006

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: 208600000X , with the licence number:  ME0046555 , 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: 01110 . This is a "UNIVERSAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204455 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30840 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 040231100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020006402 . This is a "R.R.MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5796381 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205115 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4111547 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0571459001 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040231100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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