1629019088 NPI number — ARBORETUM OBSTETRICS & GYNECOLOGY

Table of content: (NPI 1629019088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629019088 NPI number — ARBORETUM OBSTETRICS & GYNECOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARBORETUM OBSTETRICS & GYNECOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1629019088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3125 SPRINGBANK LN
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28226-3345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-341-1103
Provider Business Mailing Address Fax Number:
704-341-3460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 SPRINGBANK LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-341-1103
Provider Business Practice Location Address Fax Number:
704-341-3460
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAIGE
Authorized Official First Name:
ALIA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
704-341-1103

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  120015 , 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)





Copyright © 2007-2025 www.npivalidator.com