Healthcare Provider Details

I. General information

NPI: 1710592399
Provider Name (Legal Business Name): TRIANGLE PAIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BLUE RIDGE RD STE 330
RALEIGH NC
27607-6475
US

IV. Provider business mailing address

2605 BLUE RIDGE RD STE 330
RALEIGH NC
27607-6475
US

V. Phone/Fax

Practice location:
  • Phone: 336-575-4351
  • Fax:
Mailing address:
  • Phone: 336-575-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLYSON KOSTERMAN BRYANT
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 336-575-4351