Provider Demographics
NPI:1669444527
Name:CAHN, JACK RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:RICHARD
Last Name:CAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DOCTORS ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675
Mailing Address - Country:US
Mailing Address - Phone:336-372-5606
Mailing Address - Fax:336-372-6211
Practice Address - Street 1:214 DOCTORS ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9247
Practice Address - Country:US
Practice Address - Phone:336-372-5606
Practice Address - Fax:336-372-6211
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21734OtherMEDCOST
5001OtherPARTNERS CHOICE
VA5603595Medicaid
20644OtherNCBCBS
NC8920644Medicaid
0107814OtherUNITIED HEALTHCARE
NC205221Medicare PIN
20644OtherNCBCBS