1851302988 NPI number — KAREN GADE-PULIDO MD

Table of content: KAREN GADE-PULIDO MD (NPI 1851302988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851302988 NPI number — KAREN GADE-PULIDO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GADE-PULIDO
Provider First Name:
KAREN
Provider Middle Name:
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:
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:
1851302988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 E STATE ST STE G110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44601-4380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-596-6515
Provider Business Mailing Address Fax Number:
330-596-6517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 E STATE ST STE G110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-4380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-596-6515
Provider Business Practice Location Address Fax Number:
330-596-6517
Provider Enumeration Date:
08/11/2006

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: 208100000X , with the licence number:  35070357 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000141767 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0312656 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250011246 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341898905A . This is a "AULTCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341898905027 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341750133A . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 733365 . This is a "BUCKEYE COMM HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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