1669660627 NPI number — DR. NISHAL CHOLAPURATH RAVINDRAN M.D

Table of content: DR. NISHAL CHOLAPURATH RAVINDRAN M.D (NPI 1669660627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669660627 NPI number — DR. NISHAL CHOLAPURATH RAVINDRAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVINDRAN
Provider First Name:
NISHAL
Provider Middle Name:
CHOLAPURATH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAVINDRAN
Provider Other First Name:
CHOLAPURATH
Provider Other Middle Name:
NISHAL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669660627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N. ACADEMY AVENUE
Provider Second Line Business Mailing Address:
GEISINGER MEDICAL CENTER,
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 EASTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-745-8600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2007

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: 207R00000X , with the licence number:  MT189842 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD447165 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 243282 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MA10222800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00135881301 . This is a "UPMC ADVANTAGE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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