MEDICARE: DARYL CARDUCCI PA-C

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	0010-05619	NC

General Provider Information

NPI Number	:	1487046280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL CARDUCCI PA-C

Provider Business Mailing Address
First Line	:	PO BOX 32003
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27622-2003
Country	:	US
Telephone Number	:	919-297-0348
Fax Number	:	919-297-0349

Provider Business Practice Location Address
First Line	:	101 LATTNER CT
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6843
Country	:	US
Telephone Number	:	919-336-5663
Fax Number	:

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

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	08/24/2015

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