1417940065 NPI number — BRINDA K NAVALGUND M.D.

Table of content: BRINDA K NAVALGUND M.D. (NPI 1417940065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940065 NPI number — BRINDA K NAVALGUND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVALGUND
Provider First Name:
BRINDA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1417940065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-3787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-552-0585
Provider Business Mailing Address Fax Number:
412-235-4011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-561-7246
Provider Business Practice Location Address Fax Number:
412-235-4011
Provider Enumeration Date:
08/30/2005

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: 208VP0000X , with the licence number:  MD420107 , 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)

  • Identifier: 1008273880003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1533224 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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