1851690705 NPI number — SAGAR V.NOOTHETI,M.D.P.A

Table of content: (NPI 1851690705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851690705 NPI number — SAGAR V.NOOTHETI,M.D.P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGAR V.NOOTHETI,M.D.P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1851690705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 BERWYN HOUSE RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20740-2474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-345-0077
Provider Business Mailing Address Fax Number:
301-345-4489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 BERWYN HOUSE RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20740-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-345-0077
Provider Business Practice Location Address Fax Number:
301-345-4489
Provider Enumeration Date:
03/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RANDEV
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
301-345-0077

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  D24694 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28320001 . This is a "BC/FED" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 6480SV . This is a "BC/MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1345251700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146085200 . This is a "DEPT.OF LABOR" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 23222 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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