1275531162 NPI number — MR. RATILAL G GAJERA M.D.

Table of content: MR. RATILAL G GAJERA M.D. (NPI 1275531162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275531162 NPI number — MR. RATILAL G GAJERA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAJERA
Provider First Name:
RATILAL
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
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:
1275531162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 HIGH ST
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42240-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-885-0570
Provider Business Mailing Address Fax Number:
270-885-0573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-885-0570
Provider Business Practice Location Address Fax Number:
270-885-0573
Provider Enumeration Date:
07/13/2005

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: 207RX0202X , with the licence number:  22180 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65941031 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64221807 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000315811 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com