1245312107 NPI number — SATYA NARAYANA DANDAMUDI M.D.

Table of content: SATYA NARAYANA DANDAMUDI M.D. (NPI 1245312107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245312107 NPI number — SATYA NARAYANA DANDAMUDI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANDAMUDI
Provider First Name:
SATYA
Provider Middle Name:
NARAYANA
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:
DANDAMUDI
Provider Other First Name:
SATYANARAYANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245312107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44215 15TH ST W
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-4014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-948-4429
Provider Business Mailing Address Fax Number:
661-940-6305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44215 15TH ST W
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-4429
Provider Business Practice Location Address Fax Number:
661-940-6305
Provider Enumeration Date:
10/19/2006

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: 207R00000X , with the licence number:  A32157 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A321571 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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