Provider Demographics
NPI:1912011735
Name:VALLAT, VAL PIERRE (MD)
Entity Type:Individual
Prefix:DR
First Name:VAL PIERRE
Middle Name:
Last Name:VALLAT
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 1:3006 BAUCOM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6762
Mailing Address - Country:US
Mailing Address - Phone:704-596-1787
Mailing Address - Fax:704-596-6230
Practice Address - Street 1:3006 BAUCOM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6762
Practice Address - Country:US
Practice Address - Phone:704-596-1787
Practice Address - Fax:704-596-6230
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0179TOtherBLUE CROSS BLUE SHIELD ID
NCF43074Medicare UPIN
NC2320560Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NC2228233Medicare ID - Type UnspecifiedINDIVIDUAL IDENTIFICATION