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General NPI Number Information
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NPI Number | 1700079951
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Entity Type | Organization
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Legal Business Name | TRIANGLE SURGICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 1006 PROCURE DR SUITE 200
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-2627
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Country | US
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Telephone | 919-552-1050
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Fax | 919-552-1055
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Provider Business Mailing Address
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Address Line | 115 CRESCENT COMMONS DR SUITE 200
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City | CARY
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State | NC
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Zip | 27518-8102
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Country | US
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Telephone | 919-851-5055
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Fax | 919-851-3065
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTOR A MEDINA
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Credential | M.D.
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Telephone | 919-851-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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