Provider Demographics
NPI:1952867095
Name:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Entity Type:Organization
Organization Name:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN-OFFICE DISPENSARY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-390-3978
Mailing Address - Street 1:3821 ED DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8038
Mailing Address - Country:US
Mailing Address - Phone:919-390-3978
Mailing Address - Fax:919-390-7393
Practice Address - Street 1:3821 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8038
Practice Address - Country:US
Practice Address - Phone:919-390-3978
Practice Address - Fax:919-390-7393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site