1508088964 NPI number — ARTUN AKSADE MD

Table of content: ARTUN AKSADE MD (NPI 1508088964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508088964 NPI number — ARTUN AKSADE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKSADE
Provider First Name:
ARTUN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1508088964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 S 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-253-6201
Provider Business Mailing Address Fax Number:
610-258-4705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 S 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-253-6201
Provider Business Practice Location Address Fax Number:
610-258-4705
Provider Enumeration Date:
05/03/2007

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: 208600000X , with the licence number:  P6565 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD431044 , 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: 1019019170002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101834959 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 50081639 . This is a "CAPITAL BLUE CROSS - GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50081642 . This is a "CAPITAL BLUE CROSS - INDIV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002078081 . This is a "PA HIGHMARK BLUE SHIELD - GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 108365 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001964528 . This is a "PA HIGHMARK BLUE SHIELD - INDIV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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