1700263365 NPI number — NICHOL PITTS-MALDONADO HAIR LOSS SPECIALIST

Table of content: NICHOL PITTS-MALDONADO HAIR LOSS SPECIALIST (NPI 1700263365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700263365 NPI number — NICHOL PITTS-MALDONADO HAIR LOSS SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTS-MALDONADO
Provider First Name:
NICHOL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HAIR LOSS SPECIALIST
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:
1700263365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8611 CONCORD MILLS BLVD
Provider Second Line Business Mailing Address:
212
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28027-5400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-488-9897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5326 PROSPERITY RIDGE RD APT 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28269-0182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-488-9897
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2015

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: 1744P3200X , with the licence number:  NH 2354 , 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)





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