Healthcare Provider Details

I. General information

NPI: 1033523709
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST SUITE 300
GREENSBORO NC
27401-1000
US

IV. Provider business mailing address

PO BOX 405633
ATLANTA GA
30384-5633
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-1752
  • Fax:
Mailing address:
  • Phone: 888-563-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LEE GOLDSTEIN
Title or Position: EVP
Credential:
Phone: 336-832-6250