1841627692 NPI number — CREEDMOOR CENTRE ENDOCRINOLOGY PA

Table of content: (NPI 1841627692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841627692 NPI number — CREEDMOOR CENTRE ENDOCRINOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREEDMOOR CENTRE ENDOCRINOLOGY 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1841627692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8340 BANDFORD WAY
Provider Second Line Business Mailing Address:
SUITE 001
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-845-3332
Provider Business Mailing Address Fax Number:
919-845-3395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8340 BANDFORD WAY
Provider Second Line Business Practice Location Address:
SUITE 001
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-845-3332
Provider Business Practice Location Address Fax Number:
919-845-3395
Provider Enumeration Date:
10/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN-ULANCH
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-845-3332

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2006-01609 , 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: 5905118 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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