1063570869 NPI number — MRS. CHARYL F ALLISON CDA

Table of content: MRS. CHARYL F ALLISON CDA (NPI 1063570869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063570869 NPI number — MRS. CHARYL F ALLISON CDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLISON
Provider First Name:
CHARYL
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CDA
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:
1063570869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W TRYON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27278-2438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-245-2435
Provider Business Mailing Address Fax Number:
919-644-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N GREENSBORO ST
Provider Second Line Business Practice Location Address:
CARR MILL MALL SUITE D15
Provider Business Practice Location Address City Name:
CARRBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27510-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-968-2040
Provider Business Practice Location Address Fax Number:
919-968-2021
Provider Enumeration Date:
12/05/2006

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: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3404475 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07146 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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