Healthcare Provider Details

I. General information

NPI: 1871239525
Provider Name (Legal Business Name): GYNECOLOGY AND LAPAROSCOPIC SURGEONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 RAVEN RIDGE RD STE 109
RALEIGH NC
27614-6487
US

IV. Provider business mailing address

PO BOX 12860
BELFAST ME
04915-4019
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-7475
  • Fax: 919-847-7471
Mailing address:
  • Phone: 919-334-0123
  • Fax: 919-334-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA HERNANDEZ
Title or Position: MANAGER
Credential:
Phone: 561-300-2410