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?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty