1386633477 NPI number — MICHAEL P MADAN MD

Table of content: MICHAEL P MADAN MD (NPI 1386633477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386633477 NPI number — MICHAEL P MADAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADAN
Provider First Name:
MICHAEL
Provider Middle Name:
P
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:
1386633477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 PLEASANT STREET
Provider Second Line Business Mailing Address:
CAPITAL REGION FAMILY
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-228-7200
Provider Business Mailing Address Fax Number:
603-228-7307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PLEASANT STREET
Provider Second Line Business Practice Location Address:
CAPITAL REGION FAMILY
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-7200
Provider Business Practice Location Address Fax Number:
603-228-7307
Provider Enumeration Date:
10/20/2005

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:  13596 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4158828 . This is a "MRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: G35240 . This is a "HARVARE PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3073313 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01YP12076NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1018111 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-2594672 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2594672 . This is a "MARTIN POINT" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 4906674 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30206977 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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