Provider Demographics
NPI:1972523470
Name:CARY PRIMARY CARE PA
Entity Type:Organization
Organization Name:CARY PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STADIEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-851-3292
Mailing Address - Street 1:1151 SE CARY PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7418
Mailing Address - Country:US
Mailing Address - Phone:919-851-3292
Mailing Address - Fax:919-851-3434
Practice Address - Street 1:1151 SE CARY PKWY
Practice Address - Street 2:SUITE103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7418
Practice Address - Country:US
Practice Address - Phone:919-851-3292
Practice Address - Fax:919-851-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23233261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2319294Medicare PIN