1467422303 NPI number — DR. CHRISTOPHER DUNATOV MD

Table of content: DR. CHRISTOPHER DUNATOV MD (NPI 1467422303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467422303 NPI number — DR. CHRISTOPHER DUNATOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNATOV
Provider First Name:
CHRISTOPHER
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:
1467422303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3024 NEW BERN AVE
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:
27610-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-350-7270
Provider Business Mailing Address Fax Number:
919-350-7204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3024 NEW BERN AVE
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:
27610-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-350-7270
Provider Business Practice Location Address Fax Number:
919-350-7204
Provider Enumeration Date:
01/24/2006

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: 207RC0200X , with the licence number:  9600288 , 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: 34721 . This is a "PARTNERS MEDICARE CH-PROV" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7643527 . This is a "UNITED HCARE - PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110196987 . This is a "RAILROAD MCR- PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 91510 . This is a "MEDCOST - PROVIDERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 566000156 . This is a "TAX ID - NE MED ASSOC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8911211 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11211 . This is a "BCBS PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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