Provider Demographics
NPI:1346259702
Name:GLUYS, MARIA T (PA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:T
Last Name:GLUYS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:T
Other - Last Name:JUSSEAUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5400 S MIAMI BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8465
Mailing Address - Country:US
Mailing Address - Phone:919-941-1911
Mailing Address - Fax:919-994-1901
Practice Address - Street 1:5400 S MIAMI BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8465
Practice Address - Country:US
Practice Address - Phone:919-941-1911
Practice Address - Fax:919-941-1901
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2624973OtherUHC
Q56027Medicare UPIN
NCP00294812Medicare PIN
NC2764805Medicare PIN