Provider Demographics
NPI:1720288327
Name:NIRMAL K BANSKOTA MD INC
Entity type:Organization
Organization Name:NIRMAL K BANSKOTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSKOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-446-0559
Mailing Address - Street 1:1015 N 1ST AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2534
Mailing Address - Country:US
Mailing Address - Phone:626-446-0559
Mailing Address - Fax:626-446-0689
Practice Address - Street 1:1015 N 1ST AVE SUITE B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2534
Practice Address - Country:US
Practice Address - Phone:626-446-0559
Practice Address - Fax:626-446-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44429207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE83305Medicare UPIN