1609874619 NPI number — DR. CAROL J DARRAH M.D.

Table of content: DR. CAROL J DARRAH M.D. (NPI 1609874619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609874619 NPI number — DR. CAROL J DARRAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARRAH
Provider First Name:
CAROL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1609874619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 FENWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 OAK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24503-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-200-4072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2005

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:  0101222950 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0072-1036-1 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54-2015252 . This is a "TRICARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339622 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-0715569 . This is a "UNITED HEALTHCARE PROVIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-2015252 . This is a "PCHP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280684 . This is a "SOUTHERN HEALTH PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-2015252 . This is a "UNITED HEALTHCARE PROVIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0072-3083-4 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3202948 . This is a "CIGNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339710 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-0715569 . This is a "PCHP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0072-3086-9 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0072-4185-2 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2130249 . This is a "MAMSI HEALTH PLAN PROVIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540715569026 . This is a "TRICARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 258185 . This is a "ANTHEM PAR/PPO PROVIDER N" identifier . This identifiers is of the category "OTHER".




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