Provider Demographics
NPI:1528215019
Name:HIRACHAN, PADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PADAM
Middle Name:
Last Name:HIRACHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 JEFFERSON DAVIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5140
Mailing Address - Country:US
Mailing Address - Phone:601-273-3354
Mailing Address - Fax:601-653-9589
Practice Address - Street 1:151 JEFFERSON DAVIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5140
Practice Address - Country:US
Practice Address - Phone:601-273-3354
Practice Address - Fax:601-653-9589
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24338207RN0300X
LA301812207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02185531Medicaid
LA2434039Medicaid