Provider Demographics
NPI:1265436075
Name:CAPITAL ORTHOPAEDIC & SPORTS MEDICINE CENTER, PA
Entity type:Organization
Organization Name:CAPITAL ORTHOPAEDIC & SPORTS MEDICINE CENTER, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-876-8300
Mailing Address - Street 1:1108 DRESSER CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7328
Mailing Address - Country:US
Mailing Address - Phone:919-876-8300
Mailing Address - Fax:919-876-9690
Practice Address - Street 1:1108 DRESSER CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7328
Practice Address - Country:US
Practice Address - Phone:919-876-8300
Practice Address - Fax:919-876-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32339174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890143HMedicaid
0772Medicare UPIN