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General NPI Number Information
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NPI Number | 1982797072
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLE PULMONOLOGY CRITICAL CARE PC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 1205 CAPE CT SUITE A
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4404
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Country | US
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Telephone | 910-678-8611
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Fax | 910-678-8100
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Provider Business Mailing Address
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Address Line | 1205 CAPE CT SUITE A
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4404
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Country | US
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Telephone | 910-678-8611
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Fax | 910-678-8100
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Authorized Official
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Title or Position | MEDICAL DOCTOR PRESIDENT
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Name | GAUTAM DEV
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Credential | MD
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Telephone | 910-678-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 95-01525
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 95-01525
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License Number State | NC
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