1467641282 NPI number — BRIAN CABLE MD, INC

Table of content: MR. MARIANANDA P KUMAR MD (NPI 1316049679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467641282 NPI number — BRIAN CABLE MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN CABLE MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467641282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 B HOSPITAL DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UKIAH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95482-4561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-462-6525
Provider Business Mailing Address Fax Number:
707-462-6572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 HOSPITAL DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-6525
Provider Business Practice Location Address Fax Number:
707-462-6572
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CABLE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
707-462-6525

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G80508 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386743284 . This is a "SINGLE NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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