Provider Demographics
NPI:1508162538
Name:PASCUA, MICHAEL SOLORIA (BS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SOLORIA
Last Name:PASCUA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 US HIGHWAY 70 E STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-6522
Mailing Address - Country:US
Mailing Address - Phone:252-672-9303
Mailing Address - Fax:252-672-9302
Practice Address - Street 1:804 US HIGHWAY 70 E STE 1
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6522
Practice Address - Country:US
Practice Address - Phone:252-672-9303
Practice Address - Fax:252-672-9302
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013POOtherBCBS NC PROVIDER #
NC7200096Medicaid
NC2332578OtherMEDICARE GROUP PTAN #
NCDA4080OtherRAILROAD MEDICARE GROUP