1043565401 NPI number — DR. OUSEPH JANSO PADICKAKUDI MBBCH

Table of content: DR. OUSEPH JANSO PADICKAKUDI MBBCH (NPI 1043565401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043565401 NPI number — DR. OUSEPH JANSO PADICKAKUDI MBBCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADICKAKUDI
Provider First Name:
OUSEPH
Provider Middle Name:
JANSO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBCH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PADICKAKUDI
Provider Other First Name:
JANSON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MBBCH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043565401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 E. PRATT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N. WOLFE STREET, 655 BLALOCK
Provider Second Line Business Practice Location Address:
JOHNS HOPKINS HOSPITAL, DEPARTMENT OF SURGERY
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-502-5062
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2012

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:  7059103 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: P28117 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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