Provider Demographics
NPI:1033419569
Name:CARY ORTHOPAEDIC & SPORTS MEDICINE SPECIALISTS, PA
Entity Type:Organization
Organization Name:CARY ORTHOPAEDIC & SPORTS MEDICINE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-4992
Mailing Address - Street 1:1120 SE CARY PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7413
Mailing Address - Country:US
Mailing Address - Phone:919-467-4992
Mailing Address - Fax:919-235-0134
Practice Address - Street 1:1110 SE CARY PKWY
Practice Address - Street 2:STE 103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7420
Practice Address - Country:US
Practice Address - Phone:919-297-0000
Practice Address - Fax:919-232-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPV43190261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPV43190OtherACR AMERICAN COLLEGE OF RADIOLOGY