=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497196026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDNEY AND HYPERTENSION CENTER OF DELAWARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2013
-----------------------------------------------------
Last Update Date | 09/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 TROY RD
-----------------------------------------------------
City | DELAWARE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43015-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-368-3670
-----------------------------------------------------
Fax | 740-994-9218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 TROY RD
-----------------------------------------------------
City | DELAWARE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43015-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-362-3670
-----------------------------------------------------
Fax | 740-994-9218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAWAND SAADULLA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 740-362-3670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------