MEDICARE: UNC PHYSICIANS NETWORK GROUP PRACTICES, LLC

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
1	291U00000X	Clinical Medical Laboratory		NC

General Provider Information

NPI Number	:	1013256759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNC PHYSICIANS NETWORK GROUP PRACTICES, LLC

Provider Business Mailing Address
First Line	:	2000 PERIMETER PARK DR STE 200
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 BROWNING PL
Second Line	:	SUITE #103
City	:	RALEIGH
State	:	NC
Zip	:	27609-6510
Country	:	US
Telephone Number	:	919-781-9650
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	LYNNE CHRISTINE FISCUS
Credential	:	MD
Telephone Number	:	984-215-4111

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	08/14/2019

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