1962453225 NPI number — DR. AHSAN H KATHAWALA M.D.

Table of content: DR. AHSAN H KATHAWALA M.D. (NPI 1962453225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962453225 NPI number — DR. AHSAN H KATHAWALA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATHAWALA
Provider First Name:
AHSAN
Provider Middle Name:
H
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:
1962453225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 383317
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38183-3317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-346-1800
Provider Business Mailing Address Fax Number:
901-346-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1264 WESLEY DR
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-346-1800
Provider Business Practice Location Address Fax Number:
901-346-0043
Provider Enumeration Date:
05/12/2006

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: 207R00000X , with the licence number:  MD0000028245 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000115782 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0118459 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0441108 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4028944 . This is a "BCBST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3027560 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5009811 . This is a "TLC FAMILY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3804749 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8394237 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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