1124106554 NPI number — CATHERINE PEREZ MD

Table of content: CATHERINE PEREZ MD (NPI 1124106554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124106554 NPI number — CATHERINE PEREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
CATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1124106554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 N ELM ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-6304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-274-9617
Provider Business Mailing Address Fax Number:
336-482-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GOODMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45267-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-584-5335
Provider Business Practice Location Address Fax Number:
513-584-0431
Provider Enumeration Date:
11/02/2006

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: 2085R0202X , with the licence number:  35-06-9803-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200076020A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 658595 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000013860 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64952807 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0239021 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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