1336466150 NPI number — PADMAJA AKKINENI MD PA

Table of content: (NPI 1336466150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336466150 NPI number — PADMAJA AKKINENI MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PADMAJA AKKINENI MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336466150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7612 MEMPHIS DR
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:
75024-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-862-2978
Provider Business Mailing Address Fax Number:
972-767-3232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 WARREN PKWY
Provider Second Line Business Practice Location Address:
SUITE# 208
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-4274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-791-8225
Provider Business Practice Location Address Fax Number:
972-767-3232
Provider Enumeration Date:
05/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AKKINENI
Authorized Official First Name:
PADMAJA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE MEMBER
Authorized Official Telephone Number:
972-791-8225

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  M1457 , 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: 2831976-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com