MEDICARE: THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist		NC
2	2084P0800X	Psychiatry Physician		NC

General Provider Information

NPI Number	:	1013241892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Provider Business Mailing Address
First Line	:	110 CONNER DR
Second Line	:	SUITE 4
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-7044
Country	:	US
Telephone Number	:	919-843-7449
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 CONNER DR
Second Line	:	SUITE 4
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-7044
Country	:	US
Telephone Number	:	919-843-7449
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ALAN DAUGIRD
Credential	:	M.D.
Telephone Number	:	919-843-7449

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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