1508852351 NPI number — CARL S WERNE MD

Table of content: CARL S WERNE MD (NPI 1508852351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508852351 NPI number — CARL S WERNE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERNE
Provider First Name:
CARL
Provider Middle Name:
S
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:
1508852351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MALTESE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-342-4774
Provider Business Mailing Address Fax Number:
845-818-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13933 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DADE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33525-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-567-6763
Provider Business Practice Location Address Fax Number:
352-567-2146
Provider Enumeration Date:
09/26/2005

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: 207P00000X , with the licence number:  MD053982L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 121194 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME77701 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001487260 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 819001 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000534418 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2904218 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00260114 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014872600008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810016824 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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