Provider Demographics
NPI:1215996103
Name:CAPE FEAR FAMILY MEDICAL CARE, PA
Entity type:Organization
Organization Name:CAPE FEAR FAMILY MEDICAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:GASKINS, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-323-3183
Mailing Address - Street 1:405 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3411
Mailing Address - Country:US
Mailing Address - Phone:910-323-3183
Mailing Address - Fax:910-223-7555
Practice Address - Street 1:405 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3411
Practice Address - Country:US
Practice Address - Phone:910-323-3183
Practice Address - Fax:910-223-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20544207Q00000X
NC9501363207Q00000X
NC200825207Q00000X
NC201072207Q00000X
NC103432207Q00000X
NC200500822207Q00000X
NC9401111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00835Medicare UPIN
NC206543Medicare ID - Type Unspecified
NC2044800Medicare ID - Type Unspecified
NC2599053Medicare ID - Type Unspecified
NCH50164Medicare UPIN
NCG50171Medicare UPIN
NC2591179DMedicare ID - Type Unspecified
NC2236740Medicare ID - Type Unspecified
NCC83988Medicare UPIN
NCS69349Medicare UPIN
NCP49955Medicare UPIN
NCG82418Medicare UPIN
NC2265809AMedicare ID - Type Unspecified
NC2754455AMedicare ID - Type Unspecified