Healthcare Provider Details

I. General information

NPI: 1003968686
Provider Name (Legal Business Name): TRIANGLE SURGICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CRESCENT COMMONS DR SUITE 200
CARY NC
27518-8102
US

IV. Provider business mailing address

115 CRESCENT COMMONS DR SUITE 200
CARY NC
27518-8102
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-5055
  • Fax: 919-851-3065
Mailing address:
  • Phone: 919-851-5055
  • Fax: 919-851-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: VICTOR A MEDINA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-851-5055