1710934054 NPI number — NEW DANVILLE MEDICAL GROUP, INC

Table of content: (NPI 1710934054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710934054 NPI number — NEW DANVILLE MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DANVILLE MEDICAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1710934054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 SAN RAMON VALLEY BLVD
Provider Second Line Business Mailing Address:
SUITE #202
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94526-4036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-837-4202
Provider Business Mailing Address Fax Number:
925-838-3224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 SAN RAMON VALLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE #202
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94526-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-837-4202
Provider Business Practice Location Address Fax Number:
925-838-3224
Provider Enumeration Date:
05/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GHEEWALA
Authorized Official First Name:
UMESH
Authorized Official Middle Name:
HANASRAG
Authorized Official Title or Position:
C.E.O
Authorized Official Telephone Number:
925-837-4202

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1982608568 . This is a "UU. GHEEWALA MD NPI#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1982608576 . This is a "NPI # S MANN PA-C" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1124022710 . This is a "J. SIINO, MD NPI #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".