Healthcare Provider Details

I. General information

NPI: 1477554327
Provider Name (Legal Business Name): CAPITOL EAR, NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LAKE BOONE TRAIL SUITE 100
RALEIGH NC
27607-7529
US

IV. Provider business mailing address

4600 LAKE BOONE TRAIL SUITE 100
RALEIGH NC
27607-7529
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-1374
  • Fax: 919-571-8135
Mailing address:
  • Phone: 919-787-1374
  • Fax: 919-571-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. MARK BROWN
Title or Position: PRESIDENT
Credential: MD
Phone: 919-787-1374