1063578516 NPI number — SONALI HEMACHANDRA MD

Table of content: SONALI HEMACHANDRA MD (NPI 1063578516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063578516 NPI number — SONALI HEMACHANDRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEMACHANDRA
Provider First Name:
SONALI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1063578516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80034-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-425-9245
Provider Business Mailing Address Fax Number:
303-425-1378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3885 UPHAM ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-4880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-425-9245
Provider Business Practice Location Address Fax Number:
303-425-1378
Provider Enumeration Date:
12/29/2006

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: 207RI0200X , with the licence number:  52607 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30.56240 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32825234 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200975100 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00818289 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000644136 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com