1902910672 NPI number — WESTELL CAREW PHELAN MD

Table of content: WESTELL CAREW PHELAN MD (NPI 1902910672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902910672 NPI number — WESTELL CAREW PHELAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELAN
Provider First Name:
WESTELL
Provider Middle Name:
CAREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902910672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12017
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23612-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-867-6101
Provider Business Mailing Address Fax Number:
757-867-6587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1144 N ROAD ST
Provider Second Line Business Practice Location Address:
ALBEMARLE HOSPITAL HWY 17N
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-384-4615
Provider Business Practice Location Address Fax Number:
252-384-4684
Provider Enumeration Date:
08/18/2006

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: 2085R0202X , with the licence number:  28074 , 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: 89137F1 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137F1 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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