=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447370036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENU GOEL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1143-B EXECUTIVE CIRCLE SUITE 102
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-4437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-465-1443
-----------------------------------------------------
Fax | 919-465-1366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1143-B EXECUTIVE CIR SUITE 102
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-4571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-465-1443
-----------------------------------------------------
Fax | 919-465-1366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 9801285
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------