1801944632 NPI number — DR. SRINIVAS CHANNAPRAGADA M.D.

Table of content: DR. SRINIVAS CHANNAPRAGADA M.D. (NPI 1801944632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801944632 NPI number — DR. SRINIVAS CHANNAPRAGADA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANNAPRAGADA
Provider First Name:
SRINIVAS
Provider Middle Name:
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:
1801944632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 GREEN HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07081-3615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-522-0829
Provider Business Mailing Address Fax Number:
908-522-0849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 GREEN HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07081-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-522-0829
Provider Business Practice Location Address Fax Number:
908-522-0849
Provider Enumeration Date:
01/08/2007

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:  25MA05830600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6877702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: J5609N . This is a "HMO BLUE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 83438 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P384199 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 575293 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1115966 . This is a "HORIZON MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK3622 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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