1538139431 NPI number — MRS. STEPHANIE BURCHETT MD

Table of content: MRS. STEPHANIE BURCHETT MD (NPI 1538139431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538139431 NPI number — MRS. STEPHANIE BURCHETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURCHETT
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1538139431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 CHURCH STREET N
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-4375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-403-2276
Provider Business Mailing Address Fax Number:
704-795-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 CHURCH STREET N
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-2276
Provider Business Practice Location Address Fax Number:
704-795-2181
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: 207R00000X , with the licence number:  200001080 , 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: 127F5 . This is a "BCBS ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7782150 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 899041 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 208086951 . This is a "GROUP TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 232008 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 39562 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0443773 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110217324 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 23315 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89127F5 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102574 . This is a "WELLPATH ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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