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General NPI Number Information
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NPI Number | 1619228665
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Entity Type | Organization
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Legal Business Name | FAMILY DOCTOR CARYNC, P.L.L.C.
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Dates
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Enumeration Date | 09/29/2012
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 200 KEISLER DR STE B
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City | CARY
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State | NC
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Zip | 27518-8801
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Country | US
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Telephone | 919-859-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 200 KEISLER DR STE B
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City | CARY
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State | NC
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Zip | 27518-8801
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Country | US
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Telephone | 919-859-7177
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAMATHA AGRAWAL
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Credential | MD
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Telephone | 919-412-6073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200000169
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License Number State | NC
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