1457454886 NPI number — DR. DONNA MARY VERALDI PHD

Table of content: DR. DONNA MARY VERALDI PHD (NPI 1457454886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457454886 NPI number — DR. DONNA MARY VERALDI PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERALDI
Provider First Name:
DONNA
Provider Middle Name:
MARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1457454886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N 27TH ST
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59101-2054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-256-8004
Provider Business Mailing Address Fax Number:
406-256-2108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N 27TH ST
Provider Second Line Business Practice Location Address:
STE 320
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59101-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-256-8004
Provider Business Practice Location Address Fax Number:
406-256-2108
Provider Enumeration Date:
09/07/2006

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: 103T00000X , with the licence number:  125 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 490477 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50681 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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