1548317126 NPI number — ANUPAMA POLIYEDATH MD

Table of content: ANUPAMA POLIYEDATH MD (NPI 1548317126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548317126 NPI number — ANUPAMA POLIYEDATH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLIYEDATH
Provider First Name:
ANUPAMA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1548317126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 E DIVISADERO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93721-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-443-2682
Provider Business Mailing Address Fax Number:
559-443-2681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7202 N MILLBROOK AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-450-4463
Provider Business Practice Location Address Fax Number:
559-450-4462
Provider Enumeration Date:
01/04/2007

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: 208M00000X , with the licence number:  C55333 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: C55333 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 125048244 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 13324 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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