1083617716 NPI number — DONALD L LENDLE IX MD

Table of content: DONALD L LENDLE IX MD (NPI 1083617716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083617716 NPI number — DONALD L LENDLE IX MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENDLE
Provider First Name:
DONALD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
IX
Provider Credential Text:
MD
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:
1083617716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751803
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:
28275-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-759-7596
Provider Business Mailing Address Fax Number:
336-759-3652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1995 BETHABARA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27106-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-759-7596
Provider Business Practice Location Address Fax Number:
336-759-3652
Provider Enumeration Date:
05/27/2005

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: 207Q00000X , with the licence number:  24445 , 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: 7951670 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2578418 . This is a "AETNA HMO OPOS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58454 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 287314 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: BCBS . This is a "51670" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102267 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080118074 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00457725 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4097828 . This is a "AETNA PPO POS" identifier . This identifiers is of the category "OTHER".




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