1205895950 NPI number — AUDREY F. ECHT, MD, PA

Table of content: (NPI 1205895950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205895950 NPI number — AUDREY F. ECHT, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDREY F. ECHT, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205895950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/03/2006
NPI Reactivation Date:
04/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10931 RAVEN RIDGE RD STE 101
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:
27614-6499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-870-6600
Provider Business Mailing Address Fax Number:
919-870-1610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10931 RAVEN RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27614-6499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-870-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMBS
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
919-870-6600

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  103908 , 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)





Copyright © 2007-2024 www.npivalidator.com