1730540998 NPI number — KEVIN THOMAS DPM PC

Table of content: JYOTI BHAT M.D. (NPI 1588839500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730540998 NPI number — KEVIN THOMAS DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEVIN THOMAS DPM PC
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:
1730540998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 RIVERSIDE DR. A-101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-0121
Provider Business Mailing Address Fax Number:
410-749-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12417 OCEAN HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE A-6
Provider Business Practice Location Address City Name:
OCEAN CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21842-9521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-0121
Provider Business Practice Location Address Fax Number:
410-749-0121
Provider Enumeration Date:
03/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/ MED. DIRECTOR
Authorized Official Telephone Number:
410-749-0121

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3378055-01 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com