1003900085 NPI number — DR. VANITHA G NAIR PH.D.

Table of content: DR. VANITHA G NAIR PH.D. (NPI 1003900085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003900085 NPI number — DR. VANITHA G NAIR PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAIR
Provider First Name:
VANITHA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1003900085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 CUMBERLAND STREET, SUITE 102
Provider Second Line Business Mailing Address:
PLAZA PSYCHOLOGY AND PSYCHIATRY
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-356-1940
Provider Business Mailing Address Fax Number:
401-356-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 CUMBERLAND ST
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-356-1940
Provider Business Practice Location Address Fax Number:
401-356-1949
Provider Enumeration Date:
10/03/2006

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: 103TC0700X , with the licence number:  PS00990 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 413899 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1028940 . This is a "BEACON (NHP)" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 32047-2 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: VN64024 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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