1245398619 NPI number — SUPHICHAYA MUANGMAN M.D.

Table of content: DR. YULIUS POPLYANSKY MD (NPI 1174557102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245398619 NPI number — SUPHICHAYA MUANGMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUANGMAN
Provider First Name:
SUPHICHAYA
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:
1245398619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 STRAITS TPKE
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
MIDDLEBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06762-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-758-9100
Provider Business Mailing Address Fax Number:
203-758-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 STRAITS TPKE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
MIDDLEBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06762-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-758-9100
Provider Business Practice Location Address Fax Number:
203-758-9400
Provider Enumeration Date:
12/05/2006

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: 207RC0000X , with the licence number:  043440 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001434406 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010043440CT02 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3V0829 . This is a "HEALTHNET/COMMERCIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 518685 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1105253 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P00796456 . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3941581 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 043440 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001153600 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-33213 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7085716 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 25-33213 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com