1184835282 NPI number — DR. SANKALP CHOUDHRI M.D.

Table of content: DR. SANKALP CHOUDHRI M.D. (NPI 1184835282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184835282 NPI number — DR. SANKALP CHOUDHRI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOUDHRI
Provider First Name:
SANKALP
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1184835282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3155 E SOUTHERN AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85204-5519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-325-8173
Provider Business Mailing Address Fax Number:
480-325-8179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3155 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85204-5519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-325-8173
Provider Business Practice Location Address Fax Number:
480-325-8179
Provider Enumeration Date:
05/24/2007

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: 207RC0200X , with the licence number:  38218 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 38218 , 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: 1235274614 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 416390 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z148911 . This is a "PTAN MD ANDERSON" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 38218 . This is a "AZ LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z78334 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 336456 . This is a "GROUP MEDICAID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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