1417929076 NPI number — SANDHYA R DASARI MD

Table of content: (NPI 1487683850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417929076 NPI number — SANDHYA R DASARI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DASARI
Provider First Name:
SANDHYA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1417929076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 210A
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-577-3080
Provider Business Mailing Address Fax Number:
603-577-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 210A
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-577-3080
Provider Business Practice Location Address Fax Number:
603-577-3081
Provider Enumeration Date:
02/07/2006

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: 207R00000X , with the licence number:  218117 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 11902 , 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: 468613 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0408579 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0927995001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3359902 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA96670 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 000242201 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30207030 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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