Organization
FAYETTEVILLE PULMONOLOGY CRITICAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAUTAM DEV MD (MEDICAL DOCTOR PRESIDENT)
(910) 678-8611
Entity
Organization
Contact information
Practice address
1205 CAPE CT, SUITE A, FAYETTEVILLE, NC 28304-4404
(910) 678-8611
(910) 678-8100
Mailing address
1205 CAPE CT, SUITE A, FAYETTEVILLE, NC 28304-4404
(910) 678-8611
(910) 678-8100
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
95-01525
NC
207RP1001X
Pulmonary Disease Physician
Primary
95-01525
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0134J
BLUE CROSS
NC
05
—
890134J
—
NC
Enumeration date
10/02/2006
Last updated
01/14/2008
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