1730220963 NPI number — DR. CECIL DWIGHT PRICE M.D.

Table of content: DR. CECIL DWIGHT PRICE M.D. (NPI 1730220963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730220963 NPI number — DR. CECIL DWIGHT PRICE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
CECIL
Provider Middle Name:
DWIGHT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1730220963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7386
Provider Second Line Business Mailing Address:
WAKE FOREST UNIVERSITY STUDENT HEALTH SERVICE
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27109-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-758-5218
Provider Business Mailing Address Fax Number:
336-758-6054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WAKE FOREST UNIVERSITY - 1834 REYNOLDA ROAD
Provider Second Line Business Practice Location Address:
MACKIE HEALTH CENTER - REYNOLDS GYMNASIUM - WINGATE RD
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-758-5218
Provider Business Practice Location Address Fax Number:
336-758-6054
Provider Enumeration Date:
02/09/2007

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: 207Q00000X , with the licence number:  30846 , 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: 30846 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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