1245213222 NPI number — DR. VIJAY N KOLI M.D.

Table of content: DR. VIJAY N KOLI M.D. (NPI 1245213222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245213222 NPI number — DR. VIJAY N KOLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLI
Provider First Name:
VIJAY
Provider Middle Name:
N
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:
1245213222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 PALO ALTO RD
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78211-3791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-924-5097
Provider Business Mailing Address Fax Number:
210-924-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 PALO ALTO RD
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78211-3791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-924-5097
Provider Business Practice Location Address Fax Number:
210-924-1116
Provider Enumeration Date:
11/23/2005

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: 207Q00000X , with the licence number:  F3197 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120291303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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