Healthcare Provider Details

I. General information

NPI: 1417911322
Provider Name (Legal Business Name): TRIANGLE GASTROENTEROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ATLANTIC AVE
RALEIGH NC
27604-1502
US

IV. Provider business mailing address

2600 ATLANTIC AVENUE
RALEIGH NC
27604-1502
US

V. Phone/Fax

Practice location:
  • Phone: 919-881-9999
  • Fax: 919-881-9998
Mailing address:
  • Phone: 919-881-9999
  • Fax: 919-881-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAS0093
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2000001225578
License Number StateNC

VIII. Authorized Official

Name: DR. HIRENDRA N DOSHI
Title or Position: OWNER MD
Credential: M.D.
Phone: 919-881-9999