1285969618 NPI number — RAVI KUMAR KALIDINDI MD

Table of content: RAVI KUMAR KALIDINDI MD (NPI 1285969618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285969618 NPI number — RAVI KUMAR KALIDINDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALIDINDI
Provider First Name:
RAVI
Provider Middle Name:
KUMAR
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:
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:
1285969618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-0462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-673-0968
Provider Business Mailing Address Fax Number:
541-673-0080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 NW MEDICAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-673-0968
Provider Business Practice Location Address Fax Number:
541-673-0080
Provider Enumeration Date:
10/02/2009

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:  MD126136 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD126136 . This is a "OREGON MEDICAL BOARD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com