1144294851 NPI number — DR. HIMA B PRABHAKAR MD

Table of content: DR. HIMA B PRABHAKAR MD (NPI 1144294851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144294851 NPI number — DR. HIMA B PRABHAKAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRABHAKAR
Provider First Name:
HIMA
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
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:
1144294851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 SPRUCE STREET
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-6130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-829-6079
Provider Business Mailing Address Fax Number:
210-616-7799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 SPRUCE STREET
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-6130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-6079
Provider Business Practice Location Address Fax Number:
210-616-7799
Provider Enumeration Date:
02/17/2006

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: 2085R0202X , with the licence number:  MD442129 , 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: M8259 . This is a "TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1872640-04 . This is a "MEDICAID - STRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8S3959 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1872640-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00692121 . This is a "RR MEDICARE - STRG" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00692125 . This is a "RR MEDICARE - STRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L5908 . This is a "MEDICARE - STRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1872640-05 . This is a "MEDICAID - CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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