Basic Information
| Provider Information | |||||||||
| NPI: | 1306053640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALMODOVAR SUAREZ | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | LUIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 MANNING DR | ||||||||
| Address2: | CB#7025 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668178 | ||||||||
| FaxNumber: | 9198434999 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 MANNING DR | ||||||||
| Address2: | CB#7025 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668178 | ||||||||
| FaxNumber: | 9198434999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 248277 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 32000689 | 05 | NH | MEDICAID |