Healthcare Provider Details

I. General information

NPI: 1760702997
Provider Name (Legal Business Name): FASTMED OF CARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CORNERSTONE DR
CARY NC
27519-8453
US

IV. Provider business mailing address

935 SHOTWELL RD SUITE108
CLAYTON NC
27520-5597
US

V. Phone/Fax

Practice location:
  • Phone: 919-550-0821
  • Fax:
Mailing address:
  • Phone: 919-550-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA CATTO
Title or Position: VP OF OPERATIONS
Credential:
Phone: 919-550-0821