1285638866 NPI number — DR. ROY WHITAKER MD

Table of content: DR. ROY WHITAKER MD (NPI 1285638866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285638866 NPI number — DR. ROY WHITAKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITAKER
Provider First Name:
ROY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1285638866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27438-8157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-282-5000
Provider Business Mailing Address Fax Number:
336-482-3778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3312 BATTLEGROUND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27410-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-282-5000
Provider Business Practice Location Address Fax Number:
336-482-3778
Provider Enumeration Date:
06/10/2005

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: 207W00000X , with the licence number:  26482 , 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: 180045160 . This is a "RR MEDICARE PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89112204 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010000530 . This is a "VA MEDICAID PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 256849 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 34363 . This is a "PARTNERS PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4671676 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561783008 . This is a "TAX IDENTIFICATION #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 12204 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 277270 . This is a "ANTHEM BCBS PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: B8181 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 24168 . This is a "OPTICARE PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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