1851458327 NPI number — TRIANGLE ADVANCED DIAGNOSTIC IMAGING.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851458327 NPI number — TRIANGLE ADVANCED DIAGNOSTIC IMAGING.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIANGLE ADVANCED DIAGNOSTIC IMAGING.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851458327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 NAPERVILLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27519-8394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-372-1762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 WEST CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREEDMOOR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-372-1762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAN
Authorized Official First Name:
KIRSTEN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-372-1762

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  31412 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1457420846 . This is a "1" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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