1851307680 NPI number — GAURAV JAIN MD

Table of content: GAURAV JAIN MD (NPI 1851307680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851307680 NPI number — GAURAV JAIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAIN
Provider First Name:
GAURAV
Provider Middle Name:
Provider Name Prefix Text:
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:
1851307680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
537 STANTON CHRISTIANA RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-225-2380
Provider Business Mailing Address Fax Number:
302-225-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
537 STANTON CHRISTIANA RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-225-2380
Provider Business Practice Location Address Fax Number:
302-225-2388
Provider Enumeration Date:
08/01/2006

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: 207RG0100X , with the licence number:  C10006985 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000033352 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7510505 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: H97372 . This is a "BCBS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com