Organization
HANOVER MEDICAL SPECIALISTS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL KRIBS (CHIEF EXECUTIVE OFFICER)
(910) 815-0889
Entity
Organization
Contact information
Practice address
1515 DOCTORS CIR, WILMINGTON, NC 28401-7403
(910) 763-6332
(910) 763-0291
Mailing address
1515 DOCTORS CIR, WILMINGTON, NC 28401-7403
(910) 763-6332
(910) 763-0291
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
40135
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01740
BCBS
NC
05
—
8901740
—
NC
Enumeration date
05/27/2010
Last updated
05/27/2010
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