1609075928 NPI number — DR. NAVEED IQBAL MD

Table of content: DR. NAVEED IQBAL MD (NPI 1609075928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609075928 NPI number — DR. NAVEED IQBAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IQBAL
Provider First Name:
NAVEED
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:
1609075928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 S 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTSVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29550-5791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-861-4342
Provider Business Mailing Address Fax Number:
866-230-9736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29550-5791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-861-4342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007

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: 207RE0101X , with the licence number:  31421 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 31421 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09503344 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 571059347007 . This is a "TRICARE STANDARD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 571059347021 . This is a "BLUECHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20092972 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 314212 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000276510 . This is a "UNISON" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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