Provider Demographics
NPI:1760527220
Name:CAPE FEAR PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:CAPE FEAR PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-486-9093
Mailing Address - Street 1:PO BOX 53726
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3726
Mailing Address - Country:US
Mailing Address - Phone:910-486-9093
Mailing Address - Fax:910-486-9048
Practice Address - Street 1:516 BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4443
Practice Address - Country:US
Practice Address - Phone:910-486-9093
Practice Address - Fax:910-486-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0186MOtherBCBS
NC890186MMedicaid
NC0186MOtherBCBS
NC890186MMedicaid