1952304529 NPI number — DR. STEPHEN X SKAPEK MD

Table of content: DR. STEPHEN X SKAPEK MD (NPI 1952304529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952304529 NPI number — DR. STEPHEN X SKAPEK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKAPEK
Provider First Name:
STEPHEN
Provider Middle Name:
X
Provider Name Prefix Text:
DR.
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:
1952304529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DUMC BOX 102382
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-684-3401
Provider Business Mailing Address Fax Number:
919-681-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 ERWIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-4699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-3401
Provider Business Practice Location Address Fax Number:
919-681-7950
Provider Enumeration Date:
05/27/2005

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: 2080P0207X , with the licence number:  2024-00657 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0207X , with the licence number: 31199 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 136342001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558061 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 715419 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2612944 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6700179 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0076112 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0527903 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060514901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100049610A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q31199 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205030000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009913010 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104699550 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1141236 00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7613394 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00120392 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3838358 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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