1881673713 NPI number — ALLISON BRASHEAR MD

Table of content: ALLISON BRASHEAR MD (NPI 1881673713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881673713 NPI number — ALLISON BRASHEAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRASHEAR
Provider First Name:
ALLISON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1881673713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4610 X ST STE 3101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-1322
Provider Business Mailing Address Fax Number:
916-734-7055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 X ST STE 3101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-1322
Provider Business Practice Location Address Fax Number:
916-734-7055
Provider Enumeration Date:
01/10/2006

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: 2084N0400X , with the licence number:  2005 01903 , 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: 3810008124 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4201353 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881673713 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185410 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q01903 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141N5 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 807186 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5902788 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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