1023089422 NPI number — MR. DAVID VENTURA MEEHAN DO

Table of content: MR. DAVID VENTURA MEEHAN DO (NPI 1023089422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023089422 NPI number — MR. DAVID VENTURA MEEHAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEEHAN
Provider First Name:
DAVID
Provider Middle Name:
VENTURA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1023089422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 SHOTWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-550-5354
Provider Business Mailing Address Fax Number:
919-550-5766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 SHOTWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-550-5354
Provider Business Practice Location Address Fax Number:
919-550-5766
Provider Enumeration Date:
02/01/2006

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:  31736 , 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: 891206F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1206F . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0401760 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7210027 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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