1023268687 NPI number — DR. RUBAIYA MALLAY D.O.

Table of content: DR. RUBAIYA MALLAY D.O. (NPI 1023268687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023268687 NPI number — DR. RUBAIYA MALLAY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALLAY
Provider First Name:
RUBAIYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TALUKDAR
Provider Other First Name:
RUBAIYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023268687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13644 WALSINGHAM ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-595-2519
Provider Business Mailing Address Fax Number:
727-595-3872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13644 WALSINGHAM ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-595-2519
Provider Business Practice Location Address Fax Number:
727-595-3872
Provider Enumeration Date:
09/19/2008

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: 207RR0500X , with the licence number:  OS10496 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006502500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4039402 . This is a "MAIL HANDLERS BENEFIT PLAN (MHBP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 591273247 . This is a "TRICARE STANDARD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 362294 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2447922 . This is a "FIRST HEALTH AND COVENTRY NATIONAL NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14A3E . This is a "BCBS BLUE OPTIONS, BLUE CHOICE, FEDERAL BLUE, FLORIDA STATE, TRADITIONAL BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59127324 . This is a "UHC EMPIRE PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14A3E . This is a "BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9521897 . This is a "AETNA, PPO, HMO, EPO, MANAGED CHOICE, MEDICARE HMO/PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14A3E . This is a "OUT OF STATE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6913529 . This is a "CIGNA PPO/HMO, OPEN ACCESS AND GREATWEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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