1336153345 NPI number — RICHARD BERRY CASWELL JR. MD

Table of content: RICHARD BERRY CASWELL JR. MD (NPI 1336153345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336153345 NPI number — RICHARD BERRY CASWELL JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASWELL
Provider First Name:
RICHARD
Provider Middle Name:
BERRY
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
1336153345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 120590
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23612-0590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-867-6101
Provider Business Mailing Address Fax Number:
757-867-6588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 CARTHAGE ST
Provider Second Line Business Practice Location Address:
CENTRAL CAROLINA HOSPITAL
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-4162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-777-7092
Provider Business Practice Location Address Fax Number:
919-774-2399
Provider Enumeration Date:
07/27/2006

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: 2085R0202X , with the licence number:  26482 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 224969 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD071482L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 200301340 , 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: 89135P1 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00395923 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 135P1 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com