1093890816 NPI number — MARK A WESTCOTT MD

Table of content: MARK A WESTCOTT MD (NPI 1093890816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093890816 NPI number — MARK A WESTCOTT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTCOTT
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093890816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37950-2788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-766-8800
Provider Business Mailing Address Fax Number:
865-766-8874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E 77TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-1850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-434-2685
Provider Business Practice Location Address Fax Number:
212-434-2253
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  198175 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: 198175 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01591859 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7090307 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 703S71 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".