Basic Information
| Provider Information | |||||||||
| NPI: | 1386742419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATNAIK | ||||||||
| FirstName: | ASHA | ||||||||
| MiddleName: | LATA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 RESEARCH WAY | ||||||||
| Address2: | |||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117333526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314440580 | ||||||||
| FaxNumber: | 6314440562 | ||||||||
| Practice Location | |||||||||
| Address1: | 26 RESEARCH WAY | ||||||||
| Address2: | |||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314440580 | ||||||||
| FaxNumber: | 6314440562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5898 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35-090755 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35.090755 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RR0500X | 263442 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 6005490 | 05 | SD | MEDICAID | 35-090755 | 01 | OH | LICENSE | OTHER | 5898 | 01 | SD | LICENSE | OTHER |