1023210705 NPI number — DR. RAFFI H KADIAN DPM

Table of content: DR. RAFFI H KADIAN DPM (NPI 1023210705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023210705 NPI number — DR. RAFFI H KADIAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KADIAN
Provider First Name:
RAFFI
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1023210705
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:
PO BOX 163
Provider Second Line Business Mailing Address:
RTE 903 PINE POINT PLAZA SUITE 601
Provider Business Mailing Address City Name:
ALBRIGHTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18210-0163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-722-1238
Provider Business Mailing Address Fax Number:
215-236-8206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RTE 903 PINE POINT PLAZA
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
ALBRIGHTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18210-0163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-722-1238
Provider Business Practice Location Address Fax Number:
215-236-8206
Provider Enumeration Date:
06/04/2007

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: 213E00000X , with the licence number:  SC003243L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13585 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011322000011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001055 . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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