1245611854 NPI number — DR. SABRINA EMERALD KUNCIW M.D.

Table of content: DR. SABRINA EMERALD KUNCIW M.D. (NPI 1245611854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245611854 NPI number — DR. SABRINA EMERALD KUNCIW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNCIW
Provider First Name:
SABRINA
Provider Middle Name:
EMERALD
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:
1245611854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 NANDINA CT
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:
28311-8938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
910-907-6099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 CSH/BAACH
Provider Second Line Business Practice Location Address:
BUILDING #17005
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
12-746-2319
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2015

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:  0101261371 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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