Healthcare Provider Details

I. General information

NPI: 1265436075
Provider Name (Legal Business Name): CAPITAL ORTHOPAEDIC & SPORTS MEDICINE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 DRESSER CT
RALEIGH NC
27609-7328
US

IV. Provider business mailing address

1108 DRESSER CT
RALEIGH NC
27609-7328
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-8300
  • Fax: 919-876-9690
Mailing address:
  • Phone: 919-876-8300
  • Fax: 919-876-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number32339
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32339
License Number StateNC

VIII. Authorized Official

Name: DR. FREDERICK E BENEDICT
Title or Position: PRESIDENT
Credential: MD
Phone: 919-876-8300