1245786219 NPI number — MEGAN CHRISTINE PATTERSON RADT-1

Table of content: DR. SHYAM SUNDER POLUDASU M.D (NPI 1811171705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245786219 NPI number — MEGAN CHRISTINE PATTERSON RADT-1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
MEGAN
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RADT-1
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATTERSON
Provider Other First Name:
MEGAN
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RADT-1
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245786219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15450 COUNTY ROAD 99
Provider Second Line Business Mailing Address:
15450
Provider Business Mailing Address City Name:
WOODLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-668-9627
Provider Business Mailing Address Fax Number:
530-668-8525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15450 COUNTY ROAD 99
Provider Second Line Business Practice Location Address:
15450
Provider Business Practice Location Address City Name:
WOODLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95695-9339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-668-9627
Provider Business Practice Location Address Fax Number:
530-668-8525
Provider Enumeration Date:
08/30/2016

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: 101YA0400X , with the licence number:  EF128883 , 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)





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