1811910516 NPI number — PAMELA MEGATHLIN BROWN MD

Table of content: PAMELA MEGATHLIN BROWN MD (NPI 1811910516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811910516 NPI number — PAMELA MEGATHLIN BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
PAMELA
Provider Middle Name:
MEGATHLIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHEURICH
Provider Other First Name:
PAMELA
Provider Other Middle Name:
MEGATHLIN
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:
1811910516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CABARRUS AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-3699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-743-2247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6487 NC HIGHWAY 11 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27812-9797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-802-4589
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006

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: 207P00000X , with the licence number:  36082 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 2007-01812 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 2007-01812 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50005447 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64056096 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004962 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5908320 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000233250 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 930124031 . This is a "RR-MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3000161 . This is a "BWC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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