1356423578 NPI number — CAROLINA PEDIATRIC DYSPHAGIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356423578 NPI number — CAROLINA PEDIATRIC DYSPHAGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA PEDIATRIC DYSPHAGIA
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:
1356423578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3714 BENSON DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-7384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-877-9800
Provider Business Mailing Address Fax Number:
919-877-9408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3714 BENSON DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-7384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-877-9800
Provider Business Practice Location Address Fax Number:
919-877-9408
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMRIE
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-877-9800

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2274 , 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: 7210602 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0270V . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com