Healthcare Provider Details

I. General information

NPI: 1528639689
Provider Name (Legal Business Name): AMM HEALTHCARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NEW WAVERLY PL STE 101
CARY NC
27518-7414
US

IV. Provider business mailing address

PO BOX 986513 DEPT. 200
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 919-650-6066
  • Fax: 919-882-1378
Mailing address:
  • Phone: 910-219-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ZEN MENON
Title or Position: CEO
Credential:
Phone: 910-219-8310