1982639589 NPI number — NARCISA ADINA DUSA MD

Table of content: DARYA R BONTEMPO PLMSW (NPI 1992162614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982639589 NPI number — NARCISA ADINA DUSA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUSA
Provider First Name:
NARCISA
Provider Middle Name:
ADINA
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:
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:
1982639589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3941 LEGACY DR # 204-A223
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75023-8334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-215-2415
Provider Business Mailing Address Fax Number:
469-210-7532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7713 SAN JACINTO PL STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-3379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-215-2415
Provider Business Practice Location Address Fax Number:
469-210-7532
Provider Enumeration Date:
07/11/2006

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:  M0710 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7908655 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 171383601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171383602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8R5834 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".