1700317369 NPI number — DR. SHALLA AKBAR MBBS

Table of content: DR. SHALLA AKBAR MBBS (NPI 1700317369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700317369 NPI number — DR. SHALLA AKBAR MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKBAR
Provider First Name:
SHALLA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AKBAR
Provider Other First Name:
SHALLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MBBS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700317369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ACKERMAN RD STE 2120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43202-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-293-2064
Provider Business Mailing Address Fax Number:
614-292-7072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 W 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-5905
Provider Business Practice Location Address Fax Number:
614-293-4715
Provider Enumeration Date:
03/24/2017

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: 207ZP0104X , with the licence number:  35143779 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000788 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".