Healthcare Provider Details

I. General information

NPI: 1013159094
Provider Name (Legal Business Name): MARY CAROLYN PEAVEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 ACC BLVD STE 300
RALEIGH NC
27617-8744
US

IV. Provider business mailing address

UNC DEPARTMENT OF OB/GYN DIVISION OF REI 4002 OLD CLINIC BLDG./CB# 7570
CHAPEL HILL NC
27599-8744
US

V. Phone/Fax

Practice location:
  • Phone: 214-868-0701
  • Fax:
Mailing address:
  • Phone: 919-966-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP6499
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number158261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: