1023171121 NPI number — MRS. RACHELLE MARIA CRONIN PAC

Table of content: MRS. RACHELLE MARIA CRONIN PAC (NPI 1023171121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023171121 NPI number — MRS. RACHELLE MARIA CRONIN PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRONIN
Provider First Name:
RACHELLE
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLOSI
Provider Other First Name:
RACHELLE
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023171121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13557 STEELECROFT PKWY
Provider Second Line Business Mailing Address:
SUITE 2500
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28278-0057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-587-3200
Provider Business Mailing Address Fax Number:
704-587-0044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13557 STEELECROFT PKWY
Provider Second Line Business Practice Location Address:
SUITE 2500
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28278-0057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-587-3200
Provider Business Practice Location Address Fax Number:
704-587-0044
Provider Enumeration Date:
12/19/2006

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: 363AM0700X , with the licence number:  001000564 , 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)





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