1174738389 NPI number — VAMSI ROKKAM M.D.

Table of content: VAMSI ROKKAM M.D. (NPI 1174738389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174738389 NPI number — VAMSI ROKKAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROKKAM
Provider First Name:
VAMSI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174738389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6622 N 91ST AVE STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85305-2569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-759-6883
Provider Business Mailing Address Fax Number:
602-224-3358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6622 N 91ST AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85305-2569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-547-4668
Provider Business Practice Location Address Fax Number:
623-535-7869
Provider Enumeration Date:
05/11/2007

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: 207R00000X , with the licence number:  40917 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 49713 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2391971 . This is a "CIGNA - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100006180 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000528055 . This is a "ANTHEM - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023028O . This is a "HUMANA - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 089054 . This is a "SIHO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50015843 . This is a "PASSPORT - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: Z171026 . This is a "MEDICARE PTAN - AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 200877630 . This is a "MEDICAID - IN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2858299000 . This is a "PASSPORT ADVTG - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00439730 . This is a "RAILROAD MEDICARE - KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 958702 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0998869 . This is a "MEDICARE - KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: TP218 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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