Healthcare Provider Details

I. General information

NPI: 1477508505
Provider Name (Legal Business Name): CAROLINA VASCULAR SURGERY AND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 BENSON DRIVE, SUITE 201 CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA
RALEIGH NC
27609-7372
US

IV. Provider business mailing address

3713 BENSON DRIVE SUITE 201
RALEIGH NC
27609-7372
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-3400
  • Fax: 919-235-3401
Mailing address:
  • Phone: 919-235-3400
  • Fax: 919-235-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES E FOGARTIE JR.
Title or Position: TREASURER
Credential: MD
Phone: 919-235-3400