1992810626 NPI number — CAROLINA NEUROLOGY PA

Table of content: (NPI 1992810626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992810626 NPI number — CAROLINA NEUROLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA NEUROLOGY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1992810626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 HARTNESS RD
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
STATESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28677-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-924-7575
Provider Business Mailing Address Fax Number:
704-924-7877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 HARTNESS RD
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-924-7575
Provider Business Practice Location Address Fax Number:
704-924-7877
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCHA
Authorized Official First Name:
TRISHWANT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-924-7575

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  200001134 , 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: 127CK . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: I672 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89127CK , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7392472 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com