Provider Demographics
NPI:1558541052
Name:WASHINGTON PULMONARY ASSOCIATES, PA
Entity Type:Organization
Organization Name:WASHINGTON PULMONARY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-948-0900
Mailing Address - Street 1:1380 COWELL FARM RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3431
Mailing Address - Country:US
Mailing Address - Phone:252-946-0900
Mailing Address - Fax:252-948-0902
Practice Address - Street 1:1380 COWELL FARM RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3431
Practice Address - Country:US
Practice Address - Phone:252-946-0900
Practice Address - Fax:252-948-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901269207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891253WMedicaid
NC1253WOtherBLUE CROSS BLUE SHIELD
NC1253WOtherBLUE CROSS BLUE SHIELD
NCB89417Medicare UPIN