1609510833 NPI number — MISS DARSHINE VENUGOPAL M.B.B.S.

Table of content: MISS DARSHINE VENUGOPAL M.B.B.S. (NPI 1609510833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609510833 NPI number — MISS DARSHINE VENUGOPAL M.B.B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VENUGOPAL
Provider First Name:
DARSHINE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S.
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:
1609510833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/27/2023
NPI Reactivation Date:
02/13/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 N.E. GLEN OAK AVE., INTERNAL MEDICINE RESIDENCY
Provider Second Line Business Mailing Address:
OST ST. FRANCIS MEDICAL CENTER
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-655-2730
Provider Business Mailing Address Fax Number:
309-655-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 N.E. GLEN OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-655-6384
Provider Business Practice Location Address Fax Number:
309-655-7732
Provider Enumeration Date:
04/25/2022

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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