Provider Demographics
NPI: | 1164907523 |
---|---|
Name: | TRIANGLE MEDICAL ASSOCIATES, PC |
Entity Type: | Organization |
Organization Name: | TRIANGLE MEDICAL ASSOCIATES, PC |
Other - Org Name: | INNOVAMED |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | LETTIE |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | LEIDICH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 919-797-5114 |
Mailing Address - Street 1: | PO BOX 52720 |
Mailing Address - Street 2: | |
Mailing Address - City: | DURHAM |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27717-2720 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-797-5114 |
Mailing Address - Fax: | 919-403-2917 |
Practice Address - Street 1: | 14 CONSULTANT PL STE 250 |
Practice Address - Street 2: | |
Practice Address - City: | DURHAM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27707-6320 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-797-5114 |
Practice Address - Fax: | 919-403-2917 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-10-01 |
Last Update Date: | 2022-03-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty |