Healthcare Provider Details

I. General information

NPI: 1427680180
Provider Name (Legal Business Name): TRIANGLE FACIAL PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 FALLS OF NEUSE RD STE 204
RALEIGH NC
27615-2494
US

IV. Provider business mailing address

9104 FALLS OF NEUSE RD STE 204
RALEIGH NC
27615-2494
US

V. Phone/Fax

Practice location:
  • Phone: 919-706-4900
  • Fax: 919-706-4901
Mailing address:
  • Phone: 919-706-4900
  • Fax: 919-706-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM M BECKER
Title or Position: PRESIDENT
Credential: MD
Phone: 919-706-4900