1457422982 NPI number — NATARAJAN MANICKAM MD

Table of content: NATARAJAN MANICKAM MD (NPI 1457422982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457422982 NPI number — NATARAJAN MANICKAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANICKAM
Provider First Name:
NATARAJAN
Provider Middle Name:
Provider Name Prefix Text:
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:
1457422982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 SMITH CHURCH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE RAPIDS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27870-4914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-537-0134
Provider Business Mailing Address Fax Number:
252-537-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 SMITH CHURCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-4914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-537-0134
Provider Business Practice Location Address Fax Number:
252-537-6515
Provider Enumeration Date:
11/13/2006

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: 207RC0000X , with the licence number:  32778 , 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: 110179483 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18619 . This is a "CAPITOL BC PENN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5843073 . This is a "VIRGINIA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 028182 . This is a "VABCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 40991 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48 55339 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53872 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 20384900 . This is a "DIVISION OF COAL MINERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8953972 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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