1891800124 NPI number — NATALIE KARISHEV MD

Table of content: NATALIE KARISHEV MD (NPI 1891800124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891800124 NPI number — NATALIE KARISHEV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARISHEV
Provider First Name:
NATALIE
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:
KARYSHEVA
Provider Other First Name:
NATALYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891800124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 WOOLSEY ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94705-1975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-843-8002
Provider Business Mailing Address Fax Number:
510-845-7820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 WOOLSEY ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-1975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-843-8002
Provider Business Practice Location Address Fax Number:
510-540-4808
Provider Enumeration Date:
08/19/2006

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:  A 105280 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 432463 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 432680099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: NONE . This is a "RESIDENT-NO PROV #S" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 9699539 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".