MEDICARE: CAPE FEAR PLASTIC SURGERY 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	208200000X	Plastic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0186M	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760527220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE FEAR PLASTIC SURGERY PA

Provider Business Mailing Address
First Line	:	PO BOX 53726
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-3726
Country	:	US
Telephone Number	:	910-486-9093
Fax Number	:	910-486-9048

Provider Business Practice Location Address
First Line	:	516 BEAUMONT RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4443
Country	:	US
Telephone Number	:	910-486-9093
Fax Number	:	910-486-9048

Authorized Official
Title or Position	:	PHYSICIAN PRESIDENT
Name	:	DR. STEPHEN MITCHELL HERRING
Credential	:	MD
Telephone Number	:	910-486-9093

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/16/2007

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