1629073606 NPI number — SRIDEVI DONEPUDI M.D.

Table of content: SRIDEVI DONEPUDI M.D. (NPI 1629073606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629073606 NPI number — SRIDEVI DONEPUDI M.D.

Organization/Personal Information

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

NPI Number Information

NPI Number:
1629073606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HYGEIA DR
Provider Second Line Business Mailing Address:
SUITE 2300
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 CHRISTIANA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-327-7630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2005

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: 207Q00000X , with the licence number:  036108481 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 04-32448 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: C1-0011878 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 731672215 . This is a "CCN FIRST CHOICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "PREFERRED PLAN, INC PPO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "PROFESSIONAL BENEFIT ADMI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "UNITED (GRP 0240939)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215A . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "PHCS CORESOURCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036108481 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04932321 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "PRUDENTIAL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "UNICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2162900 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "GREAT WEST" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200438380A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731672215 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "PRINCIPAL LIFE INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 731672215 . This is a "TRUSTMARK LIFE INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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