1528149689 NPI number — RAKESH K SOOD M.D.

Table of content: RAKESH K SOOD M.D. (NPI 1528149689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528149689 NPI number — RAKESH K SOOD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOOD
Provider First Name:
RAKESH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1528149689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
436 CLAIRMONT COURT, STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-348-4422
Provider Business Mailing Address Fax Number:
434-348-4423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-348-4422
Provider Business Practice Location Address Fax Number:
434-348-4423
Provider Enumeration Date:
10/17/2006

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: 2084S0012X , with the licence number:  0101042645 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 0101042645 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 301216 . This is a "ANTHEM BLUE CROSS BLUE SHIELD OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 007100086 541581185 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528149689 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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