1063897304 NPI number — DR. SHANTA K SHRESTHA MD

Table of content: DR. SHANTA K SHRESTHA MD (NPI 1063897304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063897304 NPI number — DR. SHANTA K SHRESTHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHRESTHA
Provider First Name:
SHANTA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1063897304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03247-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-934-2060
Provider Business Mailing Address Fax Number:
603-527-7083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LRGH HOSPITALIST PROGRAM
Provider Second Line Business Practice Location Address:
80 HIGHLAND STREET
Provider Business Practice Location Address City Name:
LOCONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-527-7104
Provider Business Practice Location Address Fax Number:
603-737-6713
Provider Enumeration Date:
07/28/2015

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 18756 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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