Provider Demographics
NPI:1902843444
Name:TRIANGLE EAST SURGERY P A
Entity Type:Organization
Organization Name:TRIANGLE EAST SURGERY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-934-5441
Mailing Address - Street 1:131 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3915
Mailing Address - Country:US
Mailing Address - Phone:919-934-5441
Mailing Address - Fax:919-934-0152
Practice Address - Street 1:131 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3915
Practice Address - Country:US
Practice Address - Phone:919-934-5441
Practice Address - Fax:919-934-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0139LOtherBCBS
NC890139LMedicaid
NCDB0235OtherMEDICARE RAILROAD
NC2336400Medicare PIN