1275815110 NPI number — AURELIE O MAY NP

Table of content: AURELIE O MAY NP (NPI 1275815110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275815110 NPI number — AURELIE O MAY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAY
Provider First Name:
AURELIE
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1275815110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601067
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:
28260-1067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-667-3410
Provider Business Mailing Address Fax Number:
704-667-3479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 FAULK ST
Provider Second Line Business Practice Location Address:
SUITE 3100
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-5086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-667-3410
Provider Business Practice Location Address Fax Number:
704-667-3479
Provider Enumeration Date:
09/16/2011

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: 363L00000X , with the licence number:  100442 , 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: 1275815110 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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