Provider Demographics
NPI:1477560001
Name:TRIANGLE NEUROSURGERY, PA
Entity Type:Organization
Organization Name:TRIANGLE NEUROSURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-235-0222
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6000
Mailing Address - Country:US
Mailing Address - Phone:919-235-0222
Mailing Address - Fax:919-235-0227
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:SUITE 214
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6000
Practice Address - Country:US
Practice Address - Phone:919-235-0222
Practice Address - Fax:919-235-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011F9Medicaid
NC2344595Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NC89011F9Medicaid
NC5548120001Medicare NSC