1235171950 NPI number — THURLOW REED UNDERHILL MD

Table of content: THURLOW REED UNDERHILL MD (NPI 1235171950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235171950 NPI number — THURLOW REED UNDERHILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERHILL
Provider First Name:
THURLOW
Provider Middle Name:
REED
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:
1235171950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 896206
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:
28289-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-633-2712
Provider Business Mailing Address Fax Number:
252-633-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 NEWMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-633-2712
Provider Business Practice Location Address Fax Number:
252-633-5418
Provider Enumeration Date:
06/11/2006

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: 208800000X , with the licence number:  16962 , 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: 8984549 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02298 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".