1790744712 NPI number — DR. HEATHER DAWN PACHOLKE M.D.

Table of content: DR. HEATHER DAWN PACHOLKE M.D. (NPI 1790744712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790744712 NPI number — DR. HEATHER DAWN PACHOLKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACHOLKE
Provider First Name:
HEATHER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEEKS
Provider Other First Name:
HEATHER
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790744712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 QUEENS RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28204-3253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-333-7376
Provider Business Mailing Address Fax Number:
704-333-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 YADKIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001-3441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-984-4000
Provider Business Practice Location Address Fax Number:
704-983-8250
Provider Enumeration Date:
03/20/2006

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: 2085R0001X , with the licence number:  200500230 , 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: 2040419B . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6365761 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2040419C . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5901549 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806973 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00712368 . This is a "MEDICARE - RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2544164 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: E3975 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13933 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2040419A . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2040419D . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com