1881776151 NPI number — DR. SUSAN SAIK PEEBLES M.D.

Table of content: DR. SUSAN SAIK PEEBLES M.D. (NPI 1881776151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881776151 NPI number — DR. SUSAN SAIK PEEBLES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEEBLES
Provider First Name:
SUSAN
Provider Middle Name:
SAIK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAIK
Provider Other First Name:
DENISE
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881776151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3006 MAIL SERVICE CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27699-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-855-4700
Provider Business Mailing Address Fax Number:
919-508-0955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 VEAZEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27509-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-764-2000
Provider Business Practice Location Address Fax Number:
919-764-2000
Provider Enumeration Date:
10/19/2006

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:  28691 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 28691 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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