Provider Demographics
NPI:1619299815
Name:MICHAEL B. CAVENESS, M.D., PA
Entity Type:Organization
Organization Name:MICHAEL B. CAVENESS, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAVENESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-270-9839
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0549
Mailing Address - Country:US
Mailing Address - Phone:910-270-9839
Mailing Address - Fax:910-270-4133
Practice Address - Street 1:15444 HIGHWAY 17
Practice Address - Street 2:BLDG 9
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-270-9839
Practice Address - Fax:910-270-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 33774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty