1114907581 NPI number — DR. ROLLAND J BARRETT MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114907581 NPI number — DR. ROLLAND J BARRETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETT
Provider First Name:
ROLLAND
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1114907581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75216
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:
28275-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-718-7080
Provider Business Mailing Address Fax Number:
336-718-9622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 SILAS CREEK PKWY
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:
27103-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-277-8800
Provider Business Practice Location Address Fax Number:
336-277-8850
Provider Enumeration Date:
01/20/2006

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: 207VX0201X , with the licence number:  29214 , 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: 7401564 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3099354 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8913544 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4097887 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006005578 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52467 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13544 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 550 . This is a "PARTNERS NATIONAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P00031304 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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