1194708263 NPI number — DR. EDGAR XAVIER CORREA DPM

Table of content: DR. EDGAR XAVIER CORREA DPM (NPI 1194708263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194708263 NPI number — DR. EDGAR XAVIER CORREA DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORREA
Provider First Name:
EDGAR
Provider Middle Name:
XAVIER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1194708263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKE FOREST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27588-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-562-9410
Provider Business Mailing Address Fax Number:
919-562-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 GOVERNOR MANLY WAY
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27614-8599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-562-9410
Provider Business Practice Location Address Fax Number:
919-562-2948
Provider Enumeration Date:
11/22/2005

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: 213E00000X , with the licence number:  405 , 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: 2652188 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3377199011 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0807J . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176036 . This is a "WELLPATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46486 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 211980 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2119980 . This is a "MAMSI RALEIGH OFFICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4119980 . This is a "MAMSI DURHAM OFFICE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com