1750370995 NPI number — DR. EASWARAN PUTHUKODE VARIYAM M.D.

Table of content: DR. AHMAD W ASLAMI D.O. (NPI 1831154210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750370995 NPI number — DR. EASWARAN PUTHUKODE VARIYAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARIYAM
Provider First Name:
EASWARAN
Provider Middle Name:
PUTHUKODE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1750370995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-0764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-772-1501
Provider Business Mailing Address Fax Number:
409-772-4789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-772-1501
Provider Business Practice Location Address Fax Number:
409-772-4789
Provider Enumeration Date:
10/20/2005

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: 207RG0100X , with the licence number:  67416 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: L7612 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 041857601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20125905 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84341Z . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A032 . This is a "TRIWEST" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 041857602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64117 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64117 . This is a "PRESBYTERIAN COMMERICAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 8A3060 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100219540A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126029100 . This is a "FRISTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126029101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 67386814 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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