Healthcare Provider Details

I. General information

NPI: 1629199906
Provider Name (Legal Business Name): GREGORY C FEDERICO ORTHOTIC FITTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 NEW WAVERLY PL SUITE 140
CARY NC
27511-7406
US

IV. Provider business mailing address

580 NEW WAVERLY PL SUITE 140
CARY NC
27511-7406
US

V. Phone/Fax

Practice location:
  • Phone: 919-233-2060
  • Fax: 919-233-2959
Mailing address:
  • Phone: 919-233-2060
  • Fax: 919-233-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC17052
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC17052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: