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NPI Code Detail

MEDICARE: JANICE M. DOUGLAS AA

MEDICARE: JANICE M. DOUGLAS AA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367H00000XAnesthesiologist Assistant1000-00835NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2430027428OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000232159OTHEROHUNISON
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
47758969OTHEROHAETNA
50583328OTHEROHBCMH
6000000515963OTHEROHANTHEM
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629090998
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE M. DOUGLAS AA
Provider Business Mailing Address
First Line : 411 EMERALD LANDING DR
Second Line :
City : EMERALD ISLE
State : NC
Zip : 28594-2407
Country : US
Telephone Number : 440-289-5253
Fax Number :
Provider Business Practice Location Address
First Line : 3714 GUARDIAN AVE STE W
Second Line :
City : MOREHEAD CITY
State : NC
Zip : 28557-2975
Country : US
Telephone Number : 252-648-0409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 07/29/2021

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Directions to “ JANICE M. DOUGLAS AA” Practice Location

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