Jose Lopez Maldonado, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

102234 Issued in NC

Practice address

2604 Medical Office PL
Goldsboro, NC 27534-9417

Phone

(919) 580-0004

Fax

(919) 580-9224

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Immediate Care of Goldsboro, PLLC

  • Emergency Care Clinic/Center
  • Goldsboro, NC
  • NPI 1952397028
  Medicare reassignment
• North Sound Emergency Medicine PC

  • Emergency Medicine Physician
  • Everett, WA
  • NPI 1114937919
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391472000000",
    "number": "1487744306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349417",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 MEDICAL OFFICE PL",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349417",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "JOSE",
        "middle_name": "LOPEZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2014-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "102234",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Mahoney, P.A.
• Rudolph J Maier, MD
• Mainstreet and Kidsstreet of North Carolina PLLC
• Mainstreet and Kidsstreet of North Carolina PLLC
• Ann-Marie T. Majeskey, LCSWA
• Bahman Malekpour, M.D.
• Mary Eileen Maloy Witt, P.N.P.
• Catrina Marsh Manley, LCSW-A
• Holly Ann Manley, M.A., L.P.A.
• Kiara Manley

• Physician Assistant in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.