Organization Name: | KEITH C DAMICO PA C PROFESSIONAL ASSOCIATION |
NPI Number: | 1013088954 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEITH C DAMICO (PRESIDENT) |
Mailing Address: | 5235 Nc 226 S Marion |
State: | NC US |
Postal Code: | 287528733 |
Phone Number: | 8286523033 |
Fax Number: | 8287662849 |
NPI Enumeration Date: | 11/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 102719 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |