1083617864 NPI number — DR. MARY O THORPE AU.D.

Table of content: DR. MARY O THORPE AU.D. (NPI 1083617864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083617864 NPI number — DR. MARY O THORPE AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORPE
Provider First Name:
MARY
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.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:
1083617864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 HILLVIEW STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34239-3221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-316-0406
Provider Business Mailing Address Fax Number:
941-316-9317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 HILLVIEW STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-316-0406
Provider Business Practice Location Address Fax Number:
941-316-9317
Provider Enumeration Date:
05/24/2005

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: 237600000X , with the licence number:  AY165 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S0919 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".