1457550592 NPI number — MRS. MEGHANA ANIRUDDHA POTNIS PT

Table of content: MRS. MEGHANA ANIRUDDHA POTNIS PT (NPI 1457550592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457550592 NPI number — MRS. MEGHANA ANIRUDDHA POTNIS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTNIS
Provider First Name:
MEGHANA
Provider Middle Name:
ANIRUDDHA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAVIMANDAN
Provider Other First Name:
MEGHANA
Provider Other Middle Name:
VASUDEO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457550592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2144 SUGAR MAPLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FURLONG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18925-1534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-831-2177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 BROOKTREE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-9260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-940-3468
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2007

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: 225100000X , with the licence number:  PT016912 , 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)





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