1649488420 NPI number — DR. ANOOP K PALTA MD

Table of content: DR. ANOOP K PALTA MD (NPI 1649488420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649488420 NPI number — DR. ANOOP K PALTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALTA
Provider First Name:
ANOOP
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649488420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 5720
Provider Second Line Business Mailing Address:
PROVIDER ENROLLMENT DEPARTMENT
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32247-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-651-4488
Provider Business Mailing Address Fax Number:
407-650-7578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 HICKORY STREET
Provider Second Line Business Practice Location Address:
HOLMES REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-434-7208
Provider Business Practice Location Address Fax Number:
321-434-5344
Provider Enumeration Date:
05/18/2007

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: 208000000X , with the licence number:  ME98082 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: ME98082 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02553 . This is a "BLUE CROSS BLUE SHIELD OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME98082 . This is a "FLORIDA MEDICAL DOCTOR LI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 278612500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com