1376511659 NPI number — DR. GABRIEL ANGEL DELGADO MD

Table of content: ZEHRA SIDDIQUI DO (NPI 1740414028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376511659 NPI number — DR. GABRIEL ANGEL DELGADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELGADO
Provider First Name:
GABRIEL
Provider Middle Name:
ANGEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1376511659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60447
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:
28260-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-264-3500
Provider Business Mailing Address Fax Number:
704-417-4989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-343-9800
Provider Business Practice Location Address Fax Number:
704-347-2011
Provider Enumeration Date:
03/10/2006

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: 207RC0000X , with the licence number:  2014-00412 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 2014-00412 , 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: 9026DE . This is a "REGENCE BLUE SHIELD RIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8358343 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00079219 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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