Basic Information
| Provider Information | |||||||||
| NPI: | 1790877306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ASSOCIATES OF TRANSYLVANIA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 377 GALLIMORE RD | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287128874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849030 | ||||||||
| FaxNumber: | 8288775054 | ||||||||
| Practice Location | |||||||||
| Address1: | 377 GALLIMORE RD | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287128874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849030 | ||||||||
| FaxNumber: | 8288775054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | TERRIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8288626218 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 890108R | 05 | NC | MEDICAID | CC5045 | 01 | NC | RAILROAD MEDICARE | OTHER | 0108R | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 0637660001 | 01 | NC | PALMETTO GOVERNMENT SERVI | OTHER |