Provider Demographics
NPI:1396702007
Name:REGIONAL NEUROSURGERY PLLC
Entity type:Organization
Organization Name:REGIONAL NEUROSURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BRONEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-479-4188
Mailing Address - Street 1:3901 N ROXBORO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2181
Mailing Address - Country:US
Mailing Address - Phone:919-479-4120
Mailing Address - Fax:919-479-4204
Practice Address - Street 1:3901 N ROXBORO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2181
Practice Address - Country:US
Practice Address - Phone:919-479-4120
Practice Address - Fax:919-479-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02111OtherBCBS
NC6902111Medicaid
NC6902111Medicaid
NC2344426Medicare ID - Type Unspecified