Provider Demographics
NPI:1831129675
Name:CAPITAL NEPHROLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:CAPITAL NEPHROLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-231-3966
Mailing Address - Street 1:PO BOX 17224
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-7224
Mailing Address - Country:US
Mailing Address - Phone:919-231-3966
Mailing Address - Fax:919-231-3912
Practice Address - Street 1:2214 NELSON HWY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8923
Practice Address - Country:US
Practice Address - Phone:919-908-6080
Practice Address - Fax:919-908-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890142NMedicaid
NC0142NOtherBLUE CROSS BLUE SHIELD
NCCI0554OtherGROUP RR MEDICARE #
NC0142NOtherBLUE CROSS BLUE SHIELD
NC0142NOtherBLUE CROSS BLUE SHIELD