MEDICARE: ROLESVILLE FAMILY PRACTICE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1790003176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROLESVILLE FAMILY PRACTICE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 16215
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-6215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 SOUTHTOWN CIR
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9591
Country	:	US
Telephone Number	:	919-554-9412
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	ROBERT TAYLOR
Credential	:	MD
Telephone Number	:	919-554-9412

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	07/01/2010

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