MEDICARE: BLAIR HOLLOWAY CUNEO 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
1	363AM0700X	Medical Physician Assistant	0010-01697	NC
2	363A00000X	Physician Assistant	0010-01697	NC

General Provider Information

NPI Number	:	1508004300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR HOLLOWAY CUNEO PA-C

Provider Business Mailing Address
First Line	:	3708 FORESTVIEW RD STE 202
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2391
Country	:	US
Telephone Number	:	919-999-0831
Fax Number	:	888-394-6442

Provider Business Practice Location Address
First Line	:	3708 FORESTVIEW RD STE 202
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2391
Country	:	US
Telephone Number	:	919-999-0831
Fax Number	:	888-394-6442

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

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	11/23/2018

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Directions to “ BLAIR HOLLOWAY CUNEO PA-C” Practice Location

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