Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 9901378 | NC |
NPI | 1033132923 |
---|---|
Provider Name | Chadwick R Brasington |
First Address | Burlington, NC 27215-9714 |
Second Address | Burlington, NC 27215-9714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 22/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89131NX | (05) | NC |
H64157 | (02) | NC |