1750325841 NPI number — DR. VILAS K DESHPANDE MD

Table of content: DR. VILAS K DESHPANDE MD (NPI 1750325841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750325841 NPI number — DR. VILAS K DESHPANDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESHPANDE
Provider First Name:
VILAS
Provider Middle Name:
K
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:
1750325841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 N 17TH ST
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-5034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-434-2162
Provider Business Mailing Address Fax Number:
610-434-9370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-434-2162
Provider Business Practice Location Address Fax Number:
610-434-9370
Provider Enumeration Date:
06/16/2006

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: 208000000X , with the licence number:  025285E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1188801 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P002989 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126735 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19045 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5916060 . This is a "AETNA PPO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8276160001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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