Provider Demographics
NPI:1538124177
Name:ATLANTIC NEUROSURGERY CONSULTANTS, PA
Entity Type:Organization
Organization Name:ATLANTIC NEUROSURGERY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-937-6007
Mailing Address - Street 1:PO BOX 8781
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6781
Mailing Address - Country:US
Mailing Address - Phone:252-937-6007
Mailing Address - Fax:252-937-6005
Practice Address - Street 1:4056 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3123
Practice Address - Country:US
Practice Address - Phone:252-937-6007
Practice Address - Fax:252-937-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400101207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136TJOtherBCBS
NC136TJOtherBCBS
G62857Medicare UPIN
2029867AMedicare ID - Type Unspecified