1477505113 NPI number — DR. SANDYA THIMMAPPA M.D.

Table of content: DR. SANDYA THIMMAPPA M.D. (NPI 1477505113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477505113 NPI number — DR. SANDYA THIMMAPPA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIMMAPPA
Provider First Name:
SANDYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
THIMMAPPA
Provider Other First Name:
SANDYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477505113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 N ELM ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-1033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-378-1442
Provider Business Mailing Address Fax Number:
336-378-1970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 N ELM ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-378-1442
Provider Business Practice Location Address Fax Number:
336-378-1970
Provider Enumeration Date:
05/17/2006

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: 207W00000X , with the licence number:  200200614 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 132F9 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2135314 . This is a "UNITED HEALTHCARE OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89132F9 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25448 . This is a "OPTICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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