Healthcare Provider Details

I. General information

NPI: 1811072812
Provider Name (Legal Business Name): FAYETTEVILLE AREA HEALTH EDUCATION FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-0100
  • Fax: 910-678-0115
Mailing address:
  • Phone: 910-678-0100
  • Fax: 910-678-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSHMA SURRINDER KAPOOR
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 910-678-7230