MEDICARE: ORTHOPAEDIC SPECIALISTS OF NORTH CAROLINA, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	NC
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	NC
3	208100000X	Physical Medicine & Rehabilitation Physician	NC
4	207X00000X	Orthopaedic Surgery Physician	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649327750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC SPECIALISTS OF NORTH CAROLINA, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1107
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27588
Country	:	US
Telephone Number	:	919-562-9410
Fax Number	:	919-562-2948

Provider Business Practice Location Address
First Line	:	11221 GALLERIA AVE STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8137
Country	:	US
Telephone Number	:	919-562-9410
Fax Number	:	919-562-9425

Authorized Official
Title or Position	:	SECRETARY
Name	:	MARK WILLIAM GALLAND
Credential	:	MD
Telephone Number	:	919-562-9410

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/03/2021

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