1679542070 NPI number — MR. GREGORY TODD MESNA MD

Table of content: DR. YANELA HERNANDEZ MD (NPI 1730935164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679542070 NPI number — MR. GREGORY TODD MESNA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESNA
Provider First Name:
GREGORY
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
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:
1679542070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7407 WAYZATA BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-927-4556
Provider Business Mailing Address Fax Number:
952-897-1360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7407 WAYZATA BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-927-4556
Provider Business Practice Location Address Fax Number:
952-897-1360
Provider Enumeration Date:
03/16/2006

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: 208200000X , with the licence number:  35064 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00088815 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01020301 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 13-11226 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 652888100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109283 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24T91ME . This is a "BLUE CROSS INDIV" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24T90SO . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MN652888100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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