Provider Demographics
NPI:1235298589
Name:ALLERGY AND ASTHMA CENTER OF NORTH CAROLINA, PA
Entity type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER OF NORTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:BARDELAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-883-1393
Mailing Address - Street 1:100 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4320
Mailing Address - Country:US
Mailing Address - Phone:336-883-1393
Mailing Address - Fax:336-883-7517
Practice Address - Street 1:100 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4320
Practice Address - Country:US
Practice Address - Phone:336-883-1393
Practice Address - Fax:336-883-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344388AOtherGROUP
NC2344388OtherGROUP
NC0111XOtherBLUE CROSS BLUE SHIELD
NC2344388BOtherGROUP
NC0111XOtherBLUE CROSS - STATE
NC790111XMedicaid
NC=========OtherTIN
NC2344388BMedicare PIN
NC2344388BOtherGROUP
NC=========OtherTIN