1316043763 NPI number — NANCY M DENIZARD-THOMPSON MD

Table of content: NANCY M DENIZARD-THOMPSON MD (NPI 1316043763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316043763 NPI number — NANCY M DENIZARD-THOMPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENIZARD-THOMPSON
Provider First Name:
NANCY
Provider Middle Name:
M
Provider Name Prefix Text:
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:
DENIZARD
Provider Other First Name:
NANCY
Provider Other Middle Name:
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:
1316043763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602658
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-2011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-713-9800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006

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: 207R00000X , with the licence number:  2006-01143 , 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: 10406854 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143K7 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: Q43006 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191795 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3810007102 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5905491 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7515864 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 808452 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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