Healthcare Provider Details

I. General information

NPI: 1790115533
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DOLLEY MADISON RD SUITE 410
GREENSBORO NC
27410-5165
US

IV. Provider business mailing address

445 DOLLEY MADISON RD SUITE 410
GREENSBORO NC
27410-5165
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-1510
  • Fax: 336-292-0679
Mailing address:
  • Phone: 336-292-1510
  • Fax: 336-292-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LEE GOLDSTEIN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 336-663-5001