Provider Demographics
NPI:1033667761
Name:ID CARE OF NC PA
Entity Type:Organization
Organization Name:ID CARE OF NC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAVALIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-568-3903
Mailing Address - Street 1:1319 AVON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4423
Mailing Address - Country:US
Mailing Address - Phone:910-729-6552
Mailing Address - Fax:910-500-1002
Practice Address - Street 1:1319 AVON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4423
Practice Address - Country:US
Practice Address - Phone:910-729-6552
Practice Address - Fax:910-500-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00955207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty