1073510046 NPI number — DR. NATHAN ASHLEY WOOLWINE M.D.

Table of content: DR. NATHAN ASHLEY WOOLWINE M.D. (NPI 1073510046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073510046 NPI number — DR. NATHAN ASHLEY WOOLWINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLWINE
Provider First Name:
NATHAN
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1073510046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28237-7938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-332-0366
Provider Business Mailing Address Fax Number:
704-971-0035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 COPPERFIELD BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-786-7770
Provider Business Practice Location Address Fax Number:
704-971-0035
Provider Enumeration Date:
07/05/2005

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: 207RN0300X , with the licence number:  200400782 , 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: E3298 . This is a "MEDCOST PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5902823 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00194087 . This is a "RR MCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 805293 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7222609 . This is a "AETNA PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1398R . This is a "BCBS PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4504731 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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