1225296510 NPI number — DR. NATALIYA YATSENKO M.D.

Table of content: DR. NATALIYA YATSENKO M.D. (NPI 1225296510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225296510 NPI number — DR. NATALIYA YATSENKO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YATSENKO
Provider First Name:
NATALIYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1225296510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5617 RAMSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28311-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-483-7337
Provider Business Mailing Address Fax Number:
910-483-0648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 ATTAIN ST
Provider Second Line Business Practice Location Address:
SUITE 181
Provider Business Practice Location Address City Name:
FUQUAY VARINA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27526-1979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-557-5433
Provider Business Practice Location Address Fax Number:
919-557-6279
Provider Enumeration Date:
05/23/2008

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: 208000000X , with the licence number:  2009-01709 , 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: 19M1P . This is a "BLUE CROSS BLUE SHIELD OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6217977 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4866147 . This is a "AETNA-PRONET" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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