1871554907 NPI number — MARIA C ABELEDA MD

Table of content: MARIA C ABELEDA MD (NPI 1871554907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871554907 NPI number — MARIA C ABELEDA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABELEDA
Provider First Name:
MARIA
Provider Middle Name:
C
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:
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:
1871554907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 W RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYTHEVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24382-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-223-3200
Provider Business Mailing Address Fax Number:
276-223-0617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 W RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
WYTHEVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24382-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-223-3329
Provider Business Practice Location Address Fax Number:
276-223-0478
Provider Enumeration Date:
03/29/2006

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: 2084P0800X , with the licence number:  0101046910 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 260029949 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: C04812 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 25449400 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 244611 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 168629 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004945298 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258140 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 258141 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 170432000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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