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General NPI Number Information
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NPI Number | 1407579022
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Entity Type | Organization
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Legal Business Name | FORTIER GYNECOLOGY PLLC
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 2301 REXWOODS DR STE 114
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City | RALEIGH
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State | NC
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Zip | 27607-3366
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Country | US
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Telephone | 919-916-3333
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Fax | 984-293-6615
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Provider Business Mailing Address
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Address Line | 321 HALES WOOD RD
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City | CHAPEL HILL
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State | NC
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Zip | 27517-7228
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Country | US
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Telephone | 919-612-1102
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Fax | 919-914-6051
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | DR. KENNETH JOSEPH FORTIER
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Credential | MD
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Telephone | 919-612-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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