Healthcare Provider Details
I. General information
NPI: 1437182615
Provider Name (Legal Business Name): UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/09/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
163 MEDICAL PARK DR SUITE 210
SILER CITY NC
27344-6790
US
IV. Provider business mailing address
1600 PERIMETER PARK DR SUITE 225
MORRISVILLE NC
27560-8421
US
V. Phone/Fax
- Phone: 919-742-6032
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP2300X |
| Taxonomy | Primary Care Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ROBERT
LOUIS
GIANFORCARO
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 919-804-5064