1376564849 NPI number — DR. PALANIVEL G MOORTHY MD

Table of content: DR. PALANIVEL G MOORTHY MD (NPI 1376564849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376564849 NPI number — DR. PALANIVEL G MOORTHY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORTHY
Provider First Name:
PALANIVEL
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
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:
1376564849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 643273
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45264-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-891-2813
Provider Business Mailing Address Fax Number:
513-793-1032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 NILLES RD
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-858-6555
Provider Business Practice Location Address Fax Number:
513-858-6222
Provider Enumeration Date:
07/21/2006

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: 2084N0400X , with the licence number:  35-042652 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00062550 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0408973 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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