1649372566 NPI number — DIPES K RAY M.D., MRCP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649372566 NPI number — DIPES K RAY M.D., MRCP

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RAY

Provider First Name:

DIPES

Provider Middle Name:

K

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D., MRCP

Provider Gender Code:

M

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:

1649372566

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/31/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

446 CARATOKE HWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MOYOCK

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27958-8672

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

252-435-1275

Provider Business Mailing Address Fax Number:

855-348-4480

Provider First Line Business Practice Location Address:

446 CARATOKE HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MOYOCK

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27958-8672

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

252-435-1275

Provider Business Practice Location Address Fax Number:

855-348-4480

Provider Enumeration Date:

09/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  0101235920 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 9701854 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 129829725 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 49-D1022562 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
• Identifier: 7687230 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 010155941 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 3342321 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 61697 . This is a "OPTIMA/SENTARA" identifier . This identifiers is of the category "OTHER".
• Identifier: 861095408 . This is a "VA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 173326 . This is a "ANTHEM - BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 173327 . This is a "ANTHEM - SUFFOLK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: P00099937 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".