1912902867 NPI number — MADHURI DEEPAK DIXIT MD

Table of content: MADHURI DEEPAK DIXIT MD (NPI 1912902867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912902867 NPI number — MADHURI DEEPAK DIXIT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXIT
Provider First Name:
MADHURI
Provider Middle Name:
DEEPAK
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:
VAIDYA
Provider Other First Name:
MADHURI
Provider Other Middle Name:
MADHAVRAO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912902867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
843 MILLING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LULING
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70070-4442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-785-5852
Provider Business Mailing Address Fax Number:
985-785-5811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-601-0410
Provider Business Practice Location Address Fax Number:
985-649-8703
Provider Enumeration Date:
06/16/2005

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: 208000000X , with the licence number:  10981R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1649937 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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