Provider Demographics
NPI:1801850250
Name:TRIANGLE PRIMARY CARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:TRIANGLE PRIMARY CARE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-554-0900
Mailing Address - Street 1:851 DURHAM RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8793
Mailing Address - Country:US
Mailing Address - Phone:919-554-0900
Mailing Address - Fax:336-784-1116
Practice Address - Street 1:851 DURHAM RD
Practice Address - Street 2:SUITE D
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8793
Practice Address - Country:US
Practice Address - Phone:919-554-0900
Practice Address - Fax:336-784-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108082208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2333540OtherMEDICARE GROUP
NC89013JEMedicaid
NCDD7390OtherRR MEDICARE