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General NPI Number Information
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NPI Number | 1477508505
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Entity Type | Organization
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Legal Business Name | CAROLINA VASCULAR SURGERY AND
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 3713 BENSON DRIVE, SUITE 201 CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA
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City | RALEIGH
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State | NC
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Zip | 27609-7372
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Country | US
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Telephone | 919-235-3400
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Fax | 919-235-3401
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Provider Business Mailing Address
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Address Line | 3713 BENSON DRIVE SUITE 201
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City | RALEIGH
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State | NC
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Zip | 27609-7372
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Country | US
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Telephone | 919-235-3400
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Fax | 919-235-3401
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Authorized Official
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Title or Position | TREASURER
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Name | MR. JAMES E FOGARTIE JR.
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Credential | MD
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Telephone | 919-235-3400
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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 |
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License Number State |
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