1275768236 NPI number — DR. JENNIFER LYNN ROCHETTE LONG MD

Table of content: DR. JENNIFER LYNN ROCHETTE LONG MD (NPI 1275768236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275768236 NPI number — DR. JENNIFER LYNN ROCHETTE LONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN ROCHETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROCHETTE
Provider Other First Name:
JENNIFERR
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275768236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 BLUE RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-6478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-7490
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 BLUE RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-7490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2009

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: 208000000X , with the licence number:  2012-00012 , 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)





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