Provider Demographics
NPI:1356506992
Name:MOSES CONE AFFILIATED PHYSICIANS, INC
Entity Type:Organization
Organization Name:MOSES CONE AFFILIATED PHYSICIANS, INC
Other - Org Name:FAMILY TREE OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-832-6250
Mailing Address - Street 1:PO BOX 405633
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5633
Mailing Address - Country:US
Mailing Address - Phone:336-342-6063
Mailing Address - Fax:336-342-7847
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4652
Practice Address - Country:US
Practice Address - Phone:336-342-6063
Practice Address - Fax:336-342-7847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOSES H. CONE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356506992Medicaid
NC2335798Medicare PIN