1407856461 NPI number — DR. TOMA RADUT MD

Table of content: DR. TOMA RADUT MD (NPI 1407856461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407856461 NPI number — DR. TOMA RADUT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADUT
Provider First Name:
TOMA
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:
1407856461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-736-9188
Provider Business Mailing Address Fax Number:
704-736-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 S. GENERALS BLVX
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLNTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28092-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-736-9188
Provider Business Practice Location Address Fax Number:
704-736-9667
Provider Enumeration Date:
07/29/2005

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: 207R00000X , with the licence number:  9700719 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 4301063557 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C3175 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1066Y . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: MB08 . This is a "PRIMARY PHYSICIAN CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 891066Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1102477226 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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