1265475685 NPI number — SCOTT A SHELDON MD

Table of content: SCOTT A SHELDON MD (NPI 1265475685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265475685 NPI number — SCOTT A SHELDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELDON
Provider First Name:
SCOTT
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:
1265475685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4692 BROWNSBORO RD
Provider Second Line Business Mailing Address:
PHYSICIANS ELDERCARE, PA
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27106-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-251-1114
Provider Business Mailing Address Fax Number:
336-251-1115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4692 BROWNSBORO RD
Provider Second Line Business Practice Location Address:
PHYSICIANS ELDERCARE, PA
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27106-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-251-1114
Provider Business Practice Location Address Fax Number:
336-251-1115
Provider Enumeration Date:
06/14/2006

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: 207RG0300X , with the licence number:  200100779 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 200100779 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00345272 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 145026 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: HOSP60 . This is a "MEDICARE GROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: CN0368 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10063298 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 374872 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 503998724A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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