1033142138 NPI number — DR. ASHFAQ AHSANUDDIN M.D.

Table of content: DR. ASHFAQ AHSANUDDIN M.D. (NPI 1033142138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033142138 NPI number — DR. ASHFAQ AHSANUDDIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHSANUDDIN
Provider First Name:
ASHFAQ
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:
1033142138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 TUNNEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28805-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-298-7911
Provider Business Mailing Address Fax Number:
828-299-5885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 TUNNEL ROAD
Provider Second Line Business Practice Location Address:
CHARLES GEORGE VAMC- ASHEVILLE
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28805-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-299-2515
Provider Business Practice Location Address Fax Number:
828-299-5885
Provider Enumeration Date:
07/09/2006

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:  20312 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 2008-00231 , 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: 1801503000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 317844 . This is a "ANTHEM BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 513111001 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 010070244 . This is a "FIRST HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 042 . This is a "MTST BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 110215608 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 134443 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 293968 . This is a "MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7706176 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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