Provider Demographics
NPI:1922165018
Name:CARY GASTROENTEROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:CARY GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:919-816-4948
Mailing Address - Street 1:115 KILDAIRE PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8144
Mailing Address - Country:US
Mailing Address - Phone:919-816-4948
Mailing Address - Fax:919-233-7685
Practice Address - Street 1:115 KILDAIRE PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8144
Practice Address - Country:US
Practice Address - Phone:919-816-4948
Practice Address - Fax:919-233-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0115HOtherBCBS GRP NUMBER
NC8934199Medicaid
NC34199OtherSTEPHEN FURS NCBCBS
NC8911680Medicaid
NC7928291Medicaid
NC890115HMedicaid
NC8967772Medicaid
NC28291OtherMICHAEL DELISSIO NCBCBS
NC34199OtherSTEPHEN FURS NCBCBS
NC67772OtherMICHAEL PIKE NCBCBS
F78830Medicare UPIN
NC8911680Medicaid
I35694Medicare UPIN
G94072Medicare UPIN
NC230408Medicare ID - Type UnspecifiedMEDICARE GRP NUMBER
NC0115HOtherBCBS GRP NUMBER
204041AMedicare ID - Type UnspecifiedMICHAEL DELISSIO
NC8934199Medicaid
C89409Medicare UPIN