Healthcare Provider Details

I. General information

NPI: 1922423490
Provider Name (Legal Business Name): CARY GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 KILDAIRE PARK DR STE 201
CARY NC
27518-8144
US

IV. Provider business mailing address

115 KILDAIRE PARK DR STE 201
CARY NC
27518-8144
US

V. Phone/Fax

Practice location:
  • Phone: 919-816-4948
  • Fax: 919-233-7685
Mailing address:
  • Phone: 919-816-4948
  • Fax: 919-233-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number9801109
License Number StateNC

VIII. Authorized Official

Name: NOLA METZ ALLAN
Title or Position: PRACTICE ADMINISTRATOR
Credential: MPA
Phone: 919-816-4948