Indra de M.D., Inc.

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

C52396 Issued in CA

Legal business name

INDRA DE M.D., INC.

Practice address

2333 W March LN Ste A1
Stockton, CA 95207-5263

Phone

(209) 462-9100

Fax

(209) 462-9101

NPI assigned

Jul 23, 2007

Last updated

Mar 11, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Indra De, MDNPI 1154372951

Title

President

Phone

(209) 462-9100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Indra De, MD, PHD

  • Infectious Disease Physician
  • Stockton, CA
  • NPI 1154372951
  Medicare reassignment NPD Authorized official
• Manuel A Orellana, MD

  • Infectious Disease Physician
  • Stockton, CA
  • NPI 1609811868
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552262400000",
    "number": "1316147986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 GLEN ABBY CIR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952191800",
            "telephone_number": "209-462-9100",
            "fax_number": "209-462-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 W MARCH LN STE A1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075263",
            "telephone_number": "209-462-9100",
            "fax_number": "209-462-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDRA DE M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-23",
        "last_updated": "2019-03-11",
        "status": "A",
        "authorized_official_last_name": "DE",
        "authorized_official_first_name": "INDRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-462-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "C52396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Infectious Disease Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Infectious Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.