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General NPI Number Information
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NPI Number | 1922061902
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Entity Type | Organization
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Legal Business Name | MID CAROLINA GASTROENTEROLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 110 DENNIS DR
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City | SANFORD
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State | NC
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Zip | 27330-6343
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Country | US
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Telephone | 919-774-4511
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Fax | 919-774-3196
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Provider Business Mailing Address
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Address Line | 110 DENNIS DR
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City | SANFORD
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State | NC
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Zip | 27330-6343
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Country | US
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Telephone | 919-774-4511
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Fax | 919-774-3196
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARION B. PATE III
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Credential | MD
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Telephone | 919-774-4511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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