1265659288 NPI number — DR. WARREN T PICKARD II MD

Table of content: DR. WARREN T PICKARD II MD (NPI 1265659288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265659288 NPI number — DR. WARREN T PICKARD II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICKARD
Provider First Name:
WARREN
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
MD
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:
1265659288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4901 E NC HIGHWAY 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNS SUMMIT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27214-9719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-656-9905
Provider Business Mailing Address Fax Number:
336-656-5227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 E NC HIGHWAY 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNS SUMMIT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27214-9719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-656-9905
Provider Business Practice Location Address Fax Number:
336-656-5227
Provider Enumeration Date:
04/19/2007

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: 207Q00000X , with the licence number:  2008-00707 , 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: 1265659288 . This is a "NC BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265659288 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265659288 . This is a "AARP MEDICARE COMPLETE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265659288 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265659288 . This is a "COMMERCIAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2022597B . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265659288 . This is a "COVENTRY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5910251 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1265659288 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265659288 . This is a "BLUE MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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