1932260163 NPI number — MRS. CYNTHIA ANN METCALF OT

Table of content: MARIELLE DISCIPULO MD (NPI 1841930021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932260163 NPI number — MRS. CYNTHIA ANN METCALF OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METCALF
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERSON
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932260163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 RALEIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27565-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-693-8847
Provider Business Mailing Address Fax Number:
919-693-1620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 E MCCLANAHAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27565-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-693-6647
Provider Business Practice Location Address Fax Number:
919-693-1620
Provider Enumeration Date:
12/12/2006

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: 225X00000X , with the licence number:  6531 , 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: GROUP 1556U . This is a "BCBSOF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7302198 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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