1952356263 NPI number — DR. MARY BUSBY-WHITEHEAD M.D.

Table of content: DR. MARY BUSBY-WHITEHEAD M.D. (NPI 1952356263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952356263 NPI number — DR. MARY BUSBY-WHITEHEAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSBY-WHITEHEAD
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUSBY-WHITEHEAD
Provider Other First Name:
JAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952356263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5003 OLD CLINIC
Provider Second Line Business Mailing Address:
CB # 7550
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599-7550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-5945
Provider Business Mailing Address Fax Number:
919-962-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 FARRINGTON RD.
Provider Second Line Business Practice Location Address:
BLDG. 100
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-957-6599
Provider Business Practice Location Address Fax Number:
919-843-7231
Provider Enumeration Date:
05/24/2006

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: 207RG0300X , with the licence number:  9400213 , 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: 8986953 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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