1154300424 NPI number — CURTIS D. HASKINS MD

Table of content: MOHAMED WADI ABDI (NPI 1902614092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154300424 NPI number — CURTIS D. HASKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASKINS
Provider First Name:
CURTIS
Provider Middle Name:
D.
Provider Name Prefix Text:
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:
1154300424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 SAM RITTENBERG BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29407-3362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-556-3462
Provider Business Mailing Address Fax Number:
843-766-2103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 FOLLY RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29412-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-795-5362
Provider Business Practice Location Address Fax Number:
843-795-1921
Provider Enumeration Date:
01/13/2006

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: 207Q00000X , with the licence number:  15474 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080077152 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00797258 . This is a "RAILROAD MC ID-RSFPN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 154745 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080180693 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: E91151A634 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com