Provider Demographics
NPI:1083147425
Name:CANFAROTTA, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CANFAROTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DRIVE CB 7070
Mailing Address - Street 2:PHYSICIANS OFFICE BUILDING, RM G190A
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7070
Mailing Address - Country:US
Mailing Address - Phone:919-966-3343
Mailing Address - Fax:919-966-7941
Practice Address - Street 1:170 MANNING DRIVE CB 7070
Practice Address - Street 2:PHYSICIANS OFFICE BUILDING, RM G190A
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7070
Practice Address - Country:US
Practice Address - Phone:919-966-3343
Practice Address - Fax:919-966-7941
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227656390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program