Organization Name: | OWEN DRIVE SURGICAL CLINI |
NPI Number: | 1841448990 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MITHU CHAUDHURI (OWNDER) |
Mailing Address: | 2414 Hope Mills Rd Fayetteville |
State: | NC US |
Postal Code: | 283044264 |
Phone Number: | 9104842563 |
Fax Number: | |
NPI Enumeration Date: | 09/03/2008 |
NPI Last Update Date: | 09/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |