Basic Information
Provider Information
NPI: 1710102918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMIREZ
FirstName: KACY
MiddleName: ALYNE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: MEDICAL CENTER BLVD
Address2: DEPARTMENT OF PEDIATRICS
City: WINSTON SALEM
State: NC
PostalCode: 271570001
CountryCode: US
TelephoneNumber: 3367162011
FaxNumber:  
Practice Location
Address1: MEDICAL CENTER BLVD
Address2: DEPARTMENT OF PEDIATRICS
City: WINSTON SALEM
State: NC
PostalCode: 271570001
CountryCode: US
TelephoneNumber: 3367163009
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/16/2007
LastUpdateDate: 07/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0208X2013-01081NCY Allopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases

No ID Information.


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