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General NPI Number Information
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NPI Number | 1801800172
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Entity Type | Organization
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Legal Business Name | ADVANCED LAPAROSCOPIC ASSOCIATES, PC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 BLUE RIDGE RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27607-6474
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Country | US
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Telephone | 919-781-0815
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Fax | 919-781-0816
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Provider Business Mailing Address
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Address Line | 2801 BLUE RIDGE RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27607-6474
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Country | US
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Telephone | 919-781-0815
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Fax | 919-781-0816
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH C MORAN
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Credential | MD
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Telephone | 919-781-0815
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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 | NC
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