Provider Demographics
NPI:1295275170
Name:NC DEPT OF PUBLIC SAFETY
Entity type:Organization
Organization Name:NC DEPT OF PUBLIC SAFETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:984-255-6061
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:MAURY
Mailing Address - State:NC
Mailing Address - Zip Code:28554-0215
Mailing Address - Country:US
Mailing Address - Phone:252-747-8101
Mailing Address - Fax:
Practice Address - Street 1:2821 US 903 N
Practice Address - Street 2:
Practice Address - City:MAURY
Practice Address - State:NC
Practice Address - Zip Code:28554
Practice Address - Country:US
Practice Address - Phone:252-747-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05558251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare