Healthcare Provider Details

I. General information

NPI: 1396682282
Provider Name (Legal Business Name): MATTHEW BUSSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR CAMPUS BOX 7160
CHAPEL HILL NC
27599-7160
US

IV. Provider business mailing address

101 MANNING DR CAMPUS BOX 7160
CHAPEL HILL NC
27599-7160
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-5217
  • Fax: 984-974-3778
Mailing address:
  • Phone: 984-974-5217
  • Fax: 984-974-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL26-0208
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: