1942262498 NPI number — DR. GEETHA GURRALA M.D

Table of content: DR. GEETHA GURRALA M.D (NPI 1942262498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942262498 NPI number — DR. GEETHA GURRALA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GURRALA
Provider First Name:
GEETHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

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:
1942262498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 HOOSICK ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180-2444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-272-0232
Provider Business Mailing Address Fax Number:
518-272-4083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 HOOSICK ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-272-0232
Provider Business Practice Location Address Fax Number:
518-272-4083
Provider Enumeration Date:
04/03/2006

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: 207P00000X , with the licence number:  25MA09726400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 25MA09726400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 227601-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 048999 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100607000130 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 635085 . This is a "GHI/HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7435391 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02429638 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116ZB1 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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