1275731689 NPI number — NILADRI DAS MD

Table of content: NILADRI DAS MD (NPI 1275731689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275731689 NPI number — NILADRI DAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAS
Provider First Name:
NILADRI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAS
Provider Other First Name:
NIL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275731689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 448
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PETERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17520-0448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-391-7092
Provider Business Mailing Address Fax Number:
717-735-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 N 6TH ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19601-3096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-208-4559
Provider Business Practice Location Address Fax Number:
610-404-2240
Provider Enumeration Date:
07/06/2007

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:  MD442875 , 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)