Provider Demographics
NPI:1891705240
Name:ATKINSON, ALVAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVAN
Middle Name:W
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3214 CHARLES B ROOT WYND
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-785-0315
Mailing Address - Fax:919-787-1760
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:SUITE 203
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-785-0315
Practice Address - Fax:919-787-1760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC23356208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12167OtherBCBS NC
NC8912167Medicaid
C82645Medicare UPIN
NC12167OtherBCBS NC