Basic Information
| Provider Information | |||||||||
| NPI: | 1588614861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASTHMA AND ALLERGY ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 OLD MILL CIR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271032973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367680914 | ||||||||
| FaxNumber: | 3367601896 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 OLD MILL CIR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271032973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367680914 | ||||||||
| FaxNumber: | 3367601896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | MITCHELL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3367680914 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KI0005X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Clinical & Laboratory Immunology |
ID Information
| ID | Type | State | Issuer | Description | 891026Y | 05 | NC | MEDICAID |