1831194927 NPI number — DR. CARL MASCHAUER O.D.

Table of content: DR. CARL MASCHAUER O.D. (NPI 1831194927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831194927 NPI number — DR. CARL MASCHAUER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASCHAUER
Provider First Name:
CARL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1831194927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5991
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSTED
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00823-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-773-2020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 SUNNY ISLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00820-4493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-381-2696
Provider Business Practice Location Address Fax Number:
340-778-0977
Provider Enumeration Date:
06/16/2005

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: 152W00000X , with the licence number:  52 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000025522 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0075199000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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