MEDICARE: DENA MARIE POZEG PA-C

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	363AS0400X	Surgical Physician Assistant	01005	WV

General Provider Information

NPI Number	:	1043318611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA MARIE POZEG PA-C

Provider Business Mailing Address
First Line	:	4140 FERNCREEK DRIVE
Second Line	:	SUITE 601
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2569
Country	:	US
Telephone Number	:	910-485-3880
Fax Number	:	910-485-5341

Provider Business Practice Location Address
First Line	:	4140 FERNCREEK DRIVE
Second Line	:	SUITE 601
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2569
Country	:	US
Telephone Number	:	910-485-3880
Fax Number	:	910-485-5341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/10/2014

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