1972593853 NPI number — SANTWANA PRASAD O.D.

Table of content: SANTWANA PRASAD O.D. (NPI 1972593853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972593853 NPI number — SANTWANA PRASAD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRASAD
Provider First Name:
SANTWANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1972593853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STAFFORD ST
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01104-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-739-7367
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STAFFORD ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-739-7367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2005

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: 152WC0802X , with the licence number:  4370 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33797 . This is a "HEALTH NEW ENGLAND ID NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3875267 . This is a "AETNA/USHEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467469 . This is a "TUFTS ID NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0368977 . This is a "CIGNA HEALTHCARE ID NO." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16421 . This is a "BLUE SHIELD OF MASS ID NO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043700 . This is a "CONNECTICARE ID NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: W16421 . This is a "CT.BLUE SHIELD ID NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com