Provider Demographics
NPI:1871876441
Name:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Entity type:Organization
Organization Name:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:JALKUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-1255
Mailing Address - Street 1:2801 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6474
Mailing Address - Country:US
Mailing Address - Phone:919-758-8677
Mailing Address - Fax:919-758-8723
Practice Address - Street 1:4301 LAKE BOONE TRL
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7507
Practice Address - Country:US
Practice Address - Phone:919-782-1255
Practice Address - Fax:919-782-6056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED UROLOGISTS OF NORTH CAROLINA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty