MEDICARE: MRS. MARIA T GLUYS PA

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	363A00000X	Physician Assistant	001000223	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2624973	OTHER	NC	UHC

General Provider Information

NPI Number	:	1346259702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA T GLUYS PA

Provider Business Mailing Address
First Line	:	5400 S MIAMI BLVD
Second Line	:	SUITE 112
City	:	DURHAM
State	:	NC
Zip	:	27703-8465
Country	:	US
Telephone Number	:	919-941-1911
Fax Number	:	919-994-1901

Provider Business Practice Location Address
First Line	:	5400 S MIAMI BLVD
Second Line	:	SUITE 112
City	:	DURHAM
State	:	NC
Zip	:	27703-8465
Country	:	US
Telephone Number	:	919-941-1911
Fax Number	:	919-941-1901

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/16/2008

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