MEDICARE: MICHAEL CARNAGHI PAC

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	363A00000X	Physician Assistant	100831	NC

General Provider Information

NPI Number	:	1013955228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CARNAGHI PAC

Provider Business Mailing Address
First Line	:	1915 LENDEW ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7033
Country	:	US
Telephone Number	:	336-275-3325
Fax Number	:	336-275-5346

Provider Business Practice Location Address
First Line	:	1915 LENDEW ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7033
Country	:	US
Telephone Number	:	336-275-3325
Fax Number	:	336-275-5346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	09/10/2007

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