1548284169 NPI number — NAZANIN I KHAKPOUR MD

Table of content: NAZANIN I KHAKPOUR MD (NPI 1548284169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548284169 NPI number — NAZANIN I KHAKPOUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAKPOUR
Provider First Name:
NAZANIN
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1548284169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12902 MAGNOLIA DRIVE
Provider Second Line Business Mailing Address:
MOD A
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-745-3587
Provider Business Mailing Address Fax Number:
813-745-4226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12902 MAGNOLIA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-860-2778
Provider Business Practice Location Address Fax Number:
813-745-6511
Provider Enumeration Date:
07/27/2006

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: 208600000X , with the licence number:  ME100313 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: D63418 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0106 . This is a "CAREFIRST REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2134681 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 252001 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 408155200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64787501 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 95780 . This is a "GEISINGER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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