Healthcare Provider Details

I. General information

NPI: 1164793576
Provider Name (Legal Business Name): UNC PHYSICIANS NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 FAIRVIEW ST
CLINTON NC
28328-2311
US

IV. Provider business mailing address

1600 PERIMETER PARK DR SUITE #225
MORRISVILLE NC
27560-8421
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-6011
  • Fax: 910-592-0811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNC

VIII. Authorized Official

Name: ROBERT LOUIS GIANFORCARO
Title or Position: DIRECTOR
Credential: D.O.
Phone: 910-592-6011