Healthcare Provider Details

I. General information

NPI: 1770821233
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 3RD ST SUITE 101
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

PO BOX 29568
GREENSBORO NC
27429-9568
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-2511
  • Fax: 336-370-0287
Mailing address:
  • Phone: 336-273-2511
  • Fax: 336-370-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

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