Provider Demographics
NPI:1902090244
Name:NEUROLOGY OF CARY PLLC
Entity type:Organization
Organization Name:NEUROLOGY OF CARY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-297-0334
Mailing Address - Street 1:125 EDINBURGH DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6484
Mailing Address - Country:US
Mailing Address - Phone:919-297-0334
Mailing Address - Fax:
Practice Address - Street 1:125 EDINBURGH DR
Practice Address - Street 2:SUITE 207
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6484
Practice Address - Country:US
Practice Address - Phone:919-297-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35989174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958809Medicaid
58809OtherBLUE CROSS BLUE SHIELD
NC2340681Medicare PIN