1649299488 NPI number — DAVID B MABRY M.D.

Table of content: DAVID B MABRY M.D. (NPI 1649299488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649299488 NPI number — DAVID B MABRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MABRY
Provider First Name:
DAVID
Provider Middle Name:
B
Provider Name Prefix Text:
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:
1649299488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601067
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:
28260-1067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-667-4150
Provider Business Mailing Address Fax Number:
704-752-7040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6404 CARMEL RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226-8278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-650-2348
Provider Business Practice Location Address Fax Number:
704-752-7040
Provider Enumeration Date:
07/19/2006

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:  97-00098 , 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: N00098 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110221536 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 891113M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1113M . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1649299488 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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