1679885362 NPI number — PALLAVI SHIRSAT MD

Table of content: PALLAVI SHIRSAT MD (NPI 1679885362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679885362 NPI number — PALLAVI SHIRSAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIRSAT
Provider First Name:
PALLAVI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1679885362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 MONROE STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MINDEN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71055-3357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-377-7290
Provider Business Mailing Address Fax Number:
318-377-7290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MONROE STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MINDEN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71055-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-377-7290
Provider Business Practice Location Address Fax Number:
318-377-7290
Provider Enumeration Date:
07/09/2010

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: 207RN0300X , with the licence number:  MD.207150 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com