1366732083 NPI number — DR. SANTOSHA ADIPUDI VARDHANA M.D., PH.D

Table of content: DR. SANTOSHA ADIPUDI VARDHANA M.D., PH.D (NPI 1366732083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366732083 NPI number — DR. SANTOSHA ADIPUDI VARDHANA M.D., PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARDHANA
Provider First Name:
SANTOSHA
Provider Middle Name:
ADIPUDI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.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:
1366732083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 EAST 70TH STREET
Provider Second Line Business Mailing Address:
WEILL CORNELL IM ASSOCIATES
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-746-3587
Provider Business Mailing Address Fax Number:
212-746-8051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 EAST 70TH STREET
Provider Second Line Business Practice Location Address:
WEILL CORNELL IM ASSOCIATES
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-0012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-746-3587
Provider Business Practice Location Address Fax Number:
212-746-8051
Provider Enumeration Date:
04/14/2011

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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