MEDICARE: MR. TIMOTHY MARSHALL FLACK 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	363AM0700X	Medical Physician Assistant	0010-06646	NC
2	363A00000X	Physician Assistant	0010-06646	NC

General Provider Information

NPI Number	:	1790231223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY MARSHALL FLACK PA-C

Provider Business Mailing Address
First Line	:	3001 EDWARDS MILL RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 EDWARDS MILL RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-5600
Fax Number	:

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

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	04/03/2026

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