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General NPI Number Information
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NPI Number | 1366437915
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Entity Type | Organization
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Legal Business Name | METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 825 MAJESTIC CT STE F
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City | GASTONIA
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State | NC
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Zip | 28054-5190
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Country | US
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Telephone | 704-864-6500
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Fax | 704-864-0104
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Provider Business Mailing Address
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Address Line | PO BOX 550490
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City | GASTONIA
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State | NC
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Zip | 28055-0490
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Country | US
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Telephone | 704-864-6500
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Fax | 704-864-0104
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AUGUSTINE R EZE
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Credential | M.D.
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Telephone | 704-864-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9600205
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License Number State | NC
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