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General NPI Number Information
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NPI Number | 1205113487
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Entity Type | Organization
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Legal Business Name | PANGEA HEALTHCARE ALLIANCE
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 5111 BODIE LN
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City | GREENSBORO
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State | NC
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Zip | 27455-3463
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Country | US
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Telephone | 336-288-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 5111 BODIE LN
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City | GREENSBORO
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State | NC
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Zip | 27455-3463
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Country | US
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Telephone | 336-288-4950
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. BRENDAN MARK FITZPATRICK
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Credential | MBA
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Telephone | 336-420-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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