1598770372 NPI number — CARL RAPHAEL ST. REMY M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598770372 NPI number — CARL RAPHAEL ST. REMY M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ST. REMY

Provider First Name:

CARL

Provider Middle Name:

RAPHAEL

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1598770372

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 741593

Provider Second Line Business Mailing Address:

CHILDRENS SURGICAL SPECIALTY GROUP INC

Provider Business Mailing Address City Name:

ATLANTA

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30374-1593

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

757-668-8544

Provider Business Mailing Address Fax Number:

757-668-6544

Provider First Line Business Practice Location Address:

171 KEMPSVILLE RD

Provider Second Line Business Practice Location Address:

BUILDING A

Provider Business Practice Location Address City Name:

NORFOLK

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23502-4700

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

757-668-6550

Provider Business Practice Location Address Fax Number:

757-668-6544

Provider Enumeration Date:

07/30/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207XP3100X , with the licence number:  0101235869 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 104676 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 65775 . This is a "OPTIMA/SENTARA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 669649 . This is a "NC PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 790661P . This is a "NC MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 010060842 . This is a "VA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 010060842 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 09-01530 . This is a "UHC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 007573642 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 7338381 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 790661P . This is a "NORTH CAROLINA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1598770372 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4122371004 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".