Provider Demographics
NPI:1508829003
Name:CAPE FEAR NEUROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:CAPE FEAR NEUROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMPATH
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-323-2247
Mailing Address - Street 1:PO BOX 87049
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7049
Mailing Address - Country:US
Mailing Address - Phone:910-323-2247
Mailing Address - Fax:910-486-8064
Practice Address - Street 1:2135 VALLEYGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3750
Practice Address - Country:US
Practice Address - Phone:910-323-2247
Practice Address - Fax:910-486-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890171PMedicaid
NCCOMMERICALOtherGROUP NUMBER
NC890171PMedicaid
G39203Medicare UPIN