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General NPI Number Information
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NPI Number | 1023056603
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Entity Type | Organization
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Legal Business Name | BETHESDA CLINIC PA
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3000 BETHESDA PLACE STE 101 BETHESDA CLINIC PA
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City | WINSTON SALEM
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State | NC
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Zip | 27103
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Country | US
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Telephone | 336-765-9750
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Fax | 336-765-9710
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Provider Business Mailing Address
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Address Line | 3000 BETHESDA PLACE STE 101 BETHESDA CLINIC PA
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City | WINSTON SALEM
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State | NC
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Zip | 27103
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Country | US
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Telephone | 336-765-9750
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Fax | 336-765-9710
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Authorized Official
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Title or Position | MD
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Name | NANCY S GABY
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Credential | MD
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Telephone | 336-765-9750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 24653
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License Number State | NC
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