1740222843 NPI number — DR. RAJENDRA S TRIVEDI MD

Table of content: JENNA PERKINS DOYLE DMD (NPI 1548993900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740222843 NPI number — DR. RAJENDRA S TRIVEDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIVEDI
Provider First Name:
RAJENDRA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1740222843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24543-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-792-3730
Provider Business Mailing Address Fax Number:
434-792-6048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 RISON ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-792-3730
Provider Business Practice Location Address Fax Number:
434-792-6048
Provider Enumeration Date:
06/12/2006

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: 207Q00000X , with the licence number:  0101053147 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080163816 . This is a "PALMETTO GBA MC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 258015 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005619505 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89063VU , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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