Healthcare Provider Details

I. General information

NPI: 1578743571
Provider Name (Legal Business Name): GP MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROAD ST SUITE 105
DURHAM NC
27705-3579
US

IV. Provider business mailing address

1200 BROAD ST SUITE 105
DURHAM NC
27705-3579
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-4270
  • Fax: 919-286-4546
Mailing address:
  • Phone: 919-286-4270
  • Fax: 919-286-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number36626
License Number StateNC

VIII. Authorized Official

Name: MRS. SUSAN TURCI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 919-286-4270