1245517333 NPI number — MR. ROBERT CHADWICK HARPER IDC

Table of content: MR. ROBERT CHADWICK HARPER IDC (NPI 1245517333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245517333 NPI number — MR. ROBERT CHADWICK HARPER IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARPER
Provider First Name:
ROBERT
Provider Middle Name:
CHADWICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
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:
1245517333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 GEORGIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27104-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-575-4997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34101 FARENHOLT AVE
Provider Second Line Business Practice Location Address:
SURFACE WARFARE MEDICINE INSTITUTE
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92134-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-575-4997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2011

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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