Provider Demographics
NPI:1639223704
Name:GARVER, GLORIA (MS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:GARVER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-1055
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:3480 WAKE FOREST RD
Practice Address - Street 2:SUITE 410
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7376
Practice Address - Country:US
Practice Address - Phone:919-862-5650
Practice Address - Fax:919-862-5652
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103993363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102688Medicaid
NC8102688Medicaid
NC2766115AMedicare PIN