1881655371 NPI number — DR. PATRICK JOHN MORGANTE DO

Table of content: DR. PATRICK JOHN MORGANTE DO (NPI 1881655371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881655371 NPI number — DR. PATRICK JOHN MORGANTE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGANTE
Provider First Name:
PATRICK
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1881655371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 986513
Provider Second Line Business Mailing Address:
DEPARTMENT 100
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02298-6513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-219-8326
Provider Business Mailing Address Fax Number:
910-939-4269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVELOCK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28532-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-447-7474
Provider Business Practice Location Address Fax Number:
252-447-1050
Provider Enumeration Date:
04/01/2006

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: 207Q00000X , with the licence number:  9801723 , 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: 128K7 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89128K7 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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