Basic Information
| Provider Information | |||||||||
| NPI: | 1912134537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL JOINT CARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 MOUNT CARMEL CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275178082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192770427 | ||||||||
| FaxNumber: | 9199336881 | ||||||||
| Practice Location | |||||||||
| Address1: | 570 NEW WAVERLY PL | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192770427 | ||||||||
| FaxNumber: | 9199336881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | TAAVONI | ||||||||
| AuthorizedOfficialFirstName: | SHOHREH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 9199325700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.