1982646352 NPI number — DR. MEISHA KAMA ABBASINEJAD MD

Table of content: (NPI 1578362950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982646352 NPI number — DR. MEISHA KAMA ABBASINEJAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBASINEJAD
Provider First Name:
MEISHA
Provider Middle Name:
KAMA
Provider Name Prefix Text:
DR.
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:
1982646352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-630-1112
Provider Business Mailing Address Fax Number:
910-425-1110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 PURDUE DR
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-630-1112
Provider Business Practice Location Address Fax Number:
910-425-1110
Provider Enumeration Date:
06/12/2006

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: 208100000X , with the licence number:  200300737 , 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: P00222198 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 136C3 . This is a "BCNS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: E2365 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89136C3 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com