1871661041 NPI number — DR. UDAY S UTHAMAN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871661041 NPI number — DR. UDAY S UTHAMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UTHAMAN
Provider First Name:
UDAY
Provider Middle Name:
S
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:
1871661041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19714-8252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-737-0800
Provider Business Mailing Address Fax Number:
302-738-8169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 LIMESTONE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-737-0800
Provider Business Practice Location Address Fax Number:
302-738-4914
Provider Enumeration Date:
12/04/2006

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: 207Q00000X , with the licence number:  25MA05838200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: C1-0004306 , 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: 0849086001 . This is a "AMERIHEALTH NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1000002346 . This is a "DPCI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 223661501 . This is a "BCBS FEP DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000561501 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6361609 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: SA000001920 . This is a "AMERICHOICE NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2641132000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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