1770562936 NPI number — JOANA A FABER MD

Table of content: JOANA A FABER MD (NPI 1770562936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770562936 NPI number — JOANA A FABER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FABER
Provider First Name:
JOANA
Provider Middle Name:
A
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:
ALMEIDA
Provider Other First Name:
JOANA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770562936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SEASIDE LN APT 604
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEAIR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756-1988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-221-0370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 N SUNCOAST BLVD
Provider Second Line Business Practice Location Address:
SEVEN RIVERS MED CENTER - PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
CRYSTAL RIVER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34428-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-795-8372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2006

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: 207ZP0102X , with the licence number:  ME100427 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: C53040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: K5087 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000355713 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2398427 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64003098 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004992-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220033051 . This is a "TRAVELERS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50003208 . This is a "PASSPORT - MCD HMO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000193101 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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