MEDICARE: TRIANGLE GASTROENTEROLOGY PLLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	AS0093	NC
2	174400000X	Specialist	2000001225578	NC

General Provider Information

NPI Number	:	1417911322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIANGLE GASTROENTEROLOGY PLLC

Provider Business Mailing Address
First Line	:	2600 ATLANTIC AVENUE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1502
Country	:	US
Telephone Number	:	919-881-9999
Fax Number	:	919-881-9998

Provider Business Practice Location Address
First Line	:	2600 ATLANTIC AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1502
Country	:	US
Telephone Number	:	919-881-9999
Fax Number	:	919-881-9998

Authorized Official
Title or Position	:	OWNER MD
Name	:	DR. HIRENDRA N DOSHI
Credential	:	M.D.
Telephone Number	:	919-881-9999

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	09/29/2009

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