Provider Demographics
NPI:1811998271
Name:VIAR, JEFFREY KIP (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KIP
Last Name:VIAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 FOREST GLEN RD
Practice Address - Street 2:STE B
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-3456
Practice Address - Country:US
Practice Address - Phone:828-894-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-07-15
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
NC9901067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811998271Medicaid
NC7912153Medicaid
SCN01068Medicaid
NCNCK529AMedicare PIN
SCN01068Medicaid
NC7912153Medicaid
NCNCK529DMedicare PIN
G62731Medicare UPIN
NCNCK529CMedicare PIN
NC2401124DMedicare PIN