1649230079 NPI number — DR. PADMAVATHY TUMMALA M.D.

Table of content: DR. PADMAVATHY TUMMALA M.D. (NPI 1649230079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649230079 NPI number — DR. PADMAVATHY TUMMALA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUMMALA
Provider First Name:
PADMAVATHY
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
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:
1649230079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5757 W THUNDERBIRD RD STE W310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85306-4644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-393-2450
Provider Business Mailing Address Fax Number:
602-393-2458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 W THUNDERBIRD RD STE W310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-393-2450
Provider Business Practice Location Address Fax Number:
602-393-2458
Provider Enumeration Date:
03/28/2006

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: 207V00000X , with the licence number:  21393 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 628331 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4238300 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 07-00187 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 75736 . This is a "PACIFICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 129454 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1Z1233 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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