MEDICARE: DR. BETTY SY GO M.D.

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	207Q00000X	Family Medicine Physician	2019-01109	NC

General Provider Information

NPI Number	:	1063557015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTY SY GO M.D.

Provider Business Mailing Address
First Line	:	3305 SUNGATE BLVD # 2
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2871
Country	:	US
Telephone Number	:	919-212-0129
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 SUNGATE BLVD # 2
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2871
Country	:	US
Telephone Number	:	919-212-0129
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	05/11/2019

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