1013192582 NPI number — DR. WIPHADA PATRICIA BANDETTINI MD

Table of content: DR. WIPHADA PATRICIA BANDETTINI MD (NPI 1013192582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013192582 NPI number — DR. WIPHADA PATRICIA BANDETTINI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANDETTINI
Provider First Name:
WIPHADA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
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:
INGKANISORN
Provider Other First Name:
WIPHADA
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013192582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NATIONAL INSTITUTES OF HEALTH BLDG 10, 10 CENTER DR
Provider Second Line Business Mailing Address:
RM B1D-416
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-896-4007
Provider Business Mailing Address Fax Number:
301-896-7521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NATIONAL INSTITUTES OF HEALTH BLDG 10, 10 CENTER DR
Provider Second Line Business Practice Location Address:
RM B1D-416
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-896-4007
Provider Business Practice Location Address Fax Number:
301-896-7521
Provider Enumeration Date:
01/03/2008

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: 207RC0000X , with the licence number:  D0057808 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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