Provider Demographics
NPI:1962620997
Name:KURT G VERNON MD PA
Entity type:Organization
Organization Name:KURT G VERNON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:G
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-891-5808
Mailing Address - Street 1:3412 BIRK BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8224
Mailing Address - Country:US
Mailing Address - Phone:910-891-5808
Mailing Address - Fax:
Practice Address - Street 1:3412 BIRK BLUFF CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:910-891-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501139207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985016Medicaid
NC84580OtherMEDCOST
NC85016OtherBLUE CROSS BLUE SHEILD
2335429Medicare PIN
NC85016OtherBLUE CROSS BLUE SHEILD
F32289Medicare UPIN