1497977045 NPI number — MR. STAVRO NASHI C.P.N.P.

Table of content: MR. STAVRO NASHI C.P.N.P. (NPI 1497977045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497977045 NPI number — MR. STAVRO NASHI C.P.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASHI
Provider First Name:
STAVRO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.P.N.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NASHI
Provider Other First Name:
STEVE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.P.N.P.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497977045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIDDEFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04005-9422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-282-9080
Provider Business Mailing Address Fax Number:
207-282-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 HEALTHCARE DR
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
BIDDEFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04005-9449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-282-7531
Provider Business Practice Location Address Fax Number:
207-286-3787
Provider Enumeration Date:
05/03/2007

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: 363L00000X , with the licence number:  CNP81683 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: R043273 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: CNP81683 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1497977045 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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