MEDICARE: VETERANS AFFAIRS

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	282N00000X	General Acute Care Hospital	0199	NC

General Provider Information

NPI Number	:	1487980033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS AFFAIRS

Provider Business Mailing Address
First Line	:	1426 IDA ST APT J
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3330
Country	:	US
Telephone Number	:	919-801-3485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 IDA ST APT J
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3330
Country	:	US
Telephone Number	:	919-801-3485
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MRS. CYNTHIA MARIE GARY
Credential	:	PA
Telephone Number	:	919-801-3485

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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