1780661033 NPI number — JOSHUA C MACOMBER M.D.

Table of content: JOSHUA C MACOMBER M.D. (NPI 1780661033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780661033 NPI number — JOSHUA C MACOMBER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACOMBER
Provider First Name:
JOSHUA
Provider Middle Name:
C
Provider Name Prefix Text:
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:
1780661033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KEISLER DR
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-7083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-233-0059
Provider Business Mailing Address Fax Number:
919-233-0343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 KEISLER DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-7083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-233-0059
Provider Business Practice Location Address Fax Number:
919-233-0343
Provider Enumeration Date:
12/28/2005

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: 207RC0000X , with the licence number:  2007-00159 , 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: 2287432 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7037446 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5906315 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56-1807685 . This is a "TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5220759 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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