1730257957 NPI number — SADIA IFTIKHAR MD

Table of content: SADIA IFTIKHAR MD (NPI 1730257957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730257957 NPI number — SADIA IFTIKHAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IFTIKHAR
Provider First Name:
SADIA
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:
1730257957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 PROSPECT ST STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-725-8866
Provider Business Mailing Address Fax Number:
401-725-8868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 PROSPECT ST STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-725-8866
Provider Business Practice Location Address Fax Number:
401-725-8868
Provider Enumeration Date:
12/04/2006

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: 207R00000X , with the licence number:  MD10628 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04-05011 . This is a "UNITED" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2202307001 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 408532 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 27582 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 007009039 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2620389 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2643-9 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 404750 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AA33831 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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