Healthcare Provider Details

I. General information

NPI: 1124450572
Provider Name (Legal Business Name): CAROLINA CAPE FEAR MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

IV. Provider business mailing address

3637 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-1760
  • Fax: 910-491-1764
Mailing address:
  • Phone: 910-491-1760
  • Fax: 910-491-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number200300698
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200300698
License Number StateNC

VIII. Authorized Official

Name: DR. HARI P SAINI
Title or Position: OWNER
Credential: MD
Phone: 910-491-1760