1568487718 NPI number — DR. ALAN ROBERT THALINGER MD

Table of content: DR. ALAN ROBERT THALINGER MD (NPI 1568487718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568487718 NPI number — DR. ALAN ROBERT THALINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THALINGER
Provider First Name:
ALAN
Provider Middle Name:
ROBERT
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:
1568487718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-302-9300
Provider Business Mailing Address Fax Number:
704-302-9301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4525 CAMERON VALLEY PKWY
Provider Second Line Business Practice Location Address:
SUITE 4100
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-302-9300
Provider Business Practice Location Address Fax Number:
704-302-9301
Provider Enumeration Date:
07/12/2006

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:  23342 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 23342 , 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: 8982453 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82453 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 830007793 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".




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