Healthcare Provider Details

I. General information

NPI: 1437692902
Provider Name (Legal Business Name): ADRIAN BANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

DUMC 3677
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-2425
  • Fax:
Mailing address:
  • Phone: 919-681-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: