Provider Demographics
NPI:1255504965
Name:NAGARATINA SALEM, MD,PA
Entity Type:Organization
Organization Name:NAGARATINA SALEM, MD,PA
Other - Org Name:CRAIG RANCH PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-383-4400
Mailing Address - Street 1:6850 TPC DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3128
Mailing Address - Country:US
Mailing Address - Phone:214-383-4400
Mailing Address - Fax:214-383-4403
Practice Address - Street 1:6850 TPC DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3128
Practice Address - Country:US
Practice Address - Phone:214-383-4400
Practice Address - Fax:214-383-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010RFOtherBLUE CROSS BLUE SHIELD
TX111786306Medicaid
TX197553402Medicaid