Provider Demographics
NPI:1316999527
Name:CAPE FEAR PODIATRY ASSOCIATES, PA
Entity type:Organization
Organization Name:CAPE FEAR PODIATRY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-484-4191
Mailing Address - Street 1:1738 METROMEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-484-4191
Mailing Address - Fax:910-484-5546
Practice Address - Street 1:1738 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-484-4191
Practice Address - Fax:910-484-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0107JOtherBCBS
NC790107JMedicaid
NC0107JOtherBCBS
243042BMedicare ID - Type Unspecified
243042AMedicare ID - Type Unspecified
243042Medicare ID - Type Unspecified