1477743086 NPI number — J. STUART MCCRACKEN, M.D., P.A.

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 1477743086 NPI number — J. STUART MCCRACKEN, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. STUART MCCRACKEN, M.D., P.A.
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:
6
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:
1477743086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 N DUKE ST
Provider Second Line Business Mailing Address:
# 620
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27704-3048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-220-5439
Provider Business Mailing Address Fax Number:
919-220-8102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2609 N DUKE ST
Provider Second Line Business Practice Location Address:
# 620
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-220-5439
Provider Business Practice Location Address Fax Number:
919-220-8102
Provider Enumeration Date:
07/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCRACKEN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
STUART
Authorized Official Title or Position:
PRESIDENT, SOLE OWNER
Authorized Official Telephone Number:
919-220-5439

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  22310 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8955903 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com