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NPI Code Detail

MEDICARE: MRS. GRACE REAGAN GARACH PA-C

MEDICARE: MRS. GRACE REAGAN GARACH 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
1363A00000XPhysician Assistant0010-13705NC

General Provider Information

NPI Number : 1285419846
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRACE REAGAN GARACH PA-C
Provider Business Mailing Address
First Line : 6300 CANARY FALLS LN APT 306
Second Line :
City : RALEIGH
State : NC
Zip : 27606-5855
Country : US
Telephone Number : 910-990-0908
Fax Number :
Provider Business Practice Location Address
First Line : 2605 BLUE RIDGE RD STE 225
Second Line :
City : RALEIGH
State : NC
Zip : 27607-6459
Country : US
Telephone Number : 984-222-8000
Fax Number : 984-222-8001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2023
Last Update Date : 10/22/2023

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