1215362983 NPI number — MRS. MARY SHELDON BECKWITH PA-C MHS

Table of content: MRS. MARY SHELDON BECKWITH PA-C MHS (NPI 1215362983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215362983 NPI number — MRS. MARY SHELDON BECKWITH PA-C MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKWITH
Provider First Name:
MARY
Provider Middle Name:
SHELDON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONEY
Provider Other First Name:
MARY
Provider Other Middle Name:
SHELDON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C MHS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215362983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5324 MCFARLAND DRIVE
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-401-7733
Provider Business Mailing Address Fax Number:
919-401-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5324 MCFARLAND DRIVE
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-401-7733
Provider Business Practice Location Address Fax Number:
919-401-7767
Provider Enumeration Date:
09/12/2013

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: 363A00000X , with the licence number:  0010-04447 , 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 © 2007-2025 www.npivalidator.com