Provider Demographics
NPI:1033151212
Name:NORTH CAROLINA UROLOGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:NORTH CAROLINA UROLOGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-851-5482
Mailing Address - Street 1:160 MACGREGOR PINES DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6036
Mailing Address - Country:US
Mailing Address - Phone:919-851-5482
Mailing Address - Fax:919-859-1729
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:SUITE 205
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:919-851-5482
Practice Address - Fax:919-859-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72007208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0118WOtherBCBSNC ID
NC790118WMedicaid
NC2235785Medicare PIN
NC0118WOtherBCBSNC ID