1356562581 NPI number — MR. TERIQUE ANTOINE EPPS QMRP,QDDP,QMHP

Table of content: MR. TERIQUE ANTOINE EPPS QMRP,QDDP,QMHP (NPI 1356562581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356562581 NPI number — MR. TERIQUE ANTOINE EPPS QMRP,QDDP,QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EPPS
Provider First Name:
TERIQUE
Provider Middle Name:
ANTOINE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
QMRP,QDDP,QMHP
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:
1356562581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8712 RIVER KEEPER WAY
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:
27616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-609-8686
Provider Business Mailing Address Fax Number:
919-790-9755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 CEDAR HURST DR. SUITE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-5487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-790-7775
Provider Business Practice Location Address Fax Number:
919-790-9755
Provider Enumeration Date:
05/02/2007

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: 251B00000X , 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)





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