Provider Demographics
NPI:1780965004
Name:ASSOCIATED UROLOGISTS OF NORTH CAROLINA, PA
Entity type:Organization
Organization Name:ASSOCIATED UROLOGISTS OF NORTH CAROLINA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:KISSIAH
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BURVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-863-9441
Mailing Address - Street 1:110 KILDAIRE PARK DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-467-3203
Mailing Address - Fax:919-460-8915
Practice Address - Street 1:110 KILDAIRE PARK DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-467-3203
Practice Address - Fax:919-460-8915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty