Healthcare Provider Details

I. General information

NPI: 1447553870
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALISTS OF NORTH CAROLINA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BLUE RIDGE RD STE 320
RALEIGH NC
27607-6475
US

IV. Provider business mailing address

PO BOX 1107
WAKE FOREST NC
27588-1107
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-9410
  • Fax: 919-562-2948
Mailing address:
  • Phone: 919-562-9410
  • Fax: 919-562-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK WILLIAM GALLAND
Title or Position: SECRETARY
Credential: MD
Phone: 919-562-9410