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3480 Wake Forest Rd Suite 500 Raleigh NC 27609-7376 | |
(919) 862-5075 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Ambulatory Surgical |
Location | 3480 Wake Forest Rd, Raleigh, North Carolina |
Authorized Official Name and Position | Christopher Thomas Frederick (CFO) |
Authorized Official Contact | 9196137762 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 110566 Durham NC 27709-5566 Ph: (919) 620-4855 | 3480 Wake Forest Rd Suite 500 Raleigh NC 27609-7376 Ph: (919) 862-5075 |
NPI Number | 1700087194 |
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Provider Enumeration Date | 05/31/2007 |
Last Update Date | 10/20/2022 |
Identifier | Type | State | Issuer |
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1700087194 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
261QA1903X | Clinic/center - Ambulatory Surgical | (* (Not Available)) | Primary |
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