1225009640 NPI number — DR. SANJAY MOHAN RAMCHANDANI M.D.

Table of content: DR. SANJAY MOHAN RAMCHANDANI M.D. (NPI 1225009640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225009640 NPI number — DR. SANJAY MOHAN RAMCHANDANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMCHANDANI
Provider First Name:
SANJAY
Provider Middle Name:
MOHAN
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:
RAMCHANDANI
Provider Other First Name:
SANJAY
Provider Other Middle Name:
MOHAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225009640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 HOSPITAL AVE
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
DU BOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-1462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-371-6721
Provider Business Mailing Address Fax Number:
814-371-3921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-371-6721
Provider Business Practice Location Address Fax Number:
814-371-3921
Provider Enumeration Date:
02/01/2006

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: 207VM0101X , with the licence number:  L5107 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: MD073392L , 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: 369529 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 151866402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10296982 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020411600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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