1528030293 NPI number — DR. ROLAND NG M.D.

Table of content: DR. ROLAND NG M.D. (NPI 1528030293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528030293 NPI number — DR. ROLAND NG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NG
Provider First Name:
ROLAND
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1528030293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 NORMANDIE DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36111-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-269-6337
Provider Business Mailing Address Fax Number:
334-834-0657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 NORMANDIE DR
Provider Second Line Business Practice Location Address:
108
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36111-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-4624
Provider Business Practice Location Address Fax Number:
334-280-3628
Provider Enumeration Date:
02/06/2006

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:  00025609 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: MD 25609 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108289 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108567 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271641100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000058867 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009947465 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947475 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947485 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947425 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947455 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107013 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947435 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947515 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947445 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947495 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947535 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051504364 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009947505 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009947525 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107016 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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