1346455748 NPI number — CHARLES W STINE OD PC

Table of content: (NPI 1346455748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346455748 NPI number — CHARLES W STINE OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES W STINE OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1346455748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20118-1360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-687-3634
Provider Business Mailing Address Fax Number:
540-687-3378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 PENDLETON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-687-3634
Provider Business Practice Location Address Fax Number:
540-687-3378
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOVAK
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
CHANEL
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
540-687-3634

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  0618000238 , 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)

  • Identifier: 192987 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009231919 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0694647 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320412 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 412947 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320412 . This is a "ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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