1720201114 NPI number — DR. J ROBERT PADBERG PH.D.

Table of content: DR. J ROBERT PADBERG PH.D. (NPI 1720201114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720201114 NPI number — DR. J ROBERT PADBERG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADBERG
Provider First Name:
J
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1720201114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 FISHINGER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER ARLINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43221-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-451-2771
Provider Business Mailing Address Fax Number:
614-451-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1570 FISHINGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER ARLINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43221-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-451-2771
Provider Business Practice Location Address Fax Number:
614-451-4117
Provider Enumeration Date:
04/11/2007

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: 103TC0700X , with the licence number:  5207 , 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: CENTRAL BENEFITS . This is a "311488215000" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6149691 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2000588 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: MEDICAL MUTUAL . This is a "311488215001" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000121035 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: G10320 . This is a "MOUNT CARMEL BEHAVIORAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0005665515 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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