1972726420 NPI number — IQUBAL S. DHALIWAL, M.D.

Table of content: (NPI 1972726420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972726420 NPI number — IQUBAL S. DHALIWAL, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IQUBAL S. DHALIWAL, M.D.
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:
IQUBAL DHALIWAL
Provider Other Organization Name Type Code:
5
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:
1972726420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 COMMON ST
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
WRENTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02093-1399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-384-1821
Provider Business Mailing Address Fax Number:
508-384-0253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 COMMON ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
WRENTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02093-1399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-384-1821
Provider Business Practice Location Address Fax Number:
508-384-0253
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DHALIWAL
Authorized Official First Name:
IQUBAL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
508-384-1821

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  52229 , 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: 69591 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0075513 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0402020 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 712738 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3065391 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4125428 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17341 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com