1750304069 NPI number — KAREN D DONALD PA-C

Table of content: KAREN D DONALD PA-C (NPI 1750304069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750304069 NPI number — KAREN D DONALD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALD
Provider First Name:
KAREN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1750304069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601643
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:
28260-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-355-5100
Provider Business Mailing Address Fax Number:
704-355-5180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BLYTHE BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-355-5100
Provider Business Practice Location Address Fax Number:
704-355-5180
Provider Enumeration Date:
07/26/2006

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: 207R00000X , with the licence number:  100549 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 1434 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 100549 , 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: 0884PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750304069 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8101103 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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