Healthcare Provider Details

I. General information

NPI: 1932218070
Provider Name (Legal Business Name): TRIANGLE OBGYN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ASHVILLE AVE SUITE 200
CARY NC
27511-6134
US

IV. Provider business mailing address

400 ASHVILLE AVE SUITE 200
CARY NC
27511-6134
US

V. Phone/Fax

Practice location:
  • Phone: 919-233-1311
  • Fax: 919-233-1685
Mailing address:
  • Phone: 919-233-1311
  • Fax: 919-233-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. TOBI DICKER
Title or Position: ACCOUNTANT
Credential: ACCOUNTANT
Phone: 919-233-1311