Healthcare Provider Details

I. General information

NPI: 1972504926
Provider Name (Legal Business Name): NORTH CAROLINA EYE EAR NOSE & THROAT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 N ROXBORO ST
DURHAM NC
27704-2122
US

IV. Provider business mailing address

4102 N ROXBORO ST
DURHAM NC
27704-2122
US

V. Phone/Fax

Practice location:
  • Phone: 919-595-2000
  • Fax: 919-595-2186
Mailing address:
  • Phone: 919-595-2000
  • Fax: 919-595-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberNA
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberNA
License Number StateNC

VIII. Authorized Official

Name: MELISSA B MYERS
Title or Position: PATIENT ACCOUNTING MANGER
Credential:
Phone: 919-595-2106