1528084159 NPI number — DR. RITA MADRAZO-PETERSON PH.D.

Table of content: DR. RITA MADRAZO-PETERSON PH.D. (NPI 1528084159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528084159 NPI number — DR. RITA MADRAZO-PETERSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADRAZO-PETERSON
Provider First Name:
RITA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1528084159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 BAYBERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27517-8394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-932-1680
Provider Business Mailing Address Fax Number:
919-960-5126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 W NC HIGHWAY 54
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-5571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-932-1680
Provider Business Practice Location Address Fax Number:
919-960-5126
Provider Enumeration Date:
07/15/2006

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: 103TC1900X , with the licence number:  2953 , 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: 6000411 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74982851 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133885 . This is a "GHI, BMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331072 . This is a "MHN/HMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133885 . This is a "VALUEOPTIONS, CDPHP, CHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14214800 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0451U . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 230304 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4619612 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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