Basic Information
| Provider Information | |||||||||
| NPI: | 1912273699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CURZAN | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | HACKELING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HACKELING | ||||||||
| OtherFirstName: | THERESA | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 781 AVENT FERRY RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275407776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195676120 | ||||||||
| FaxNumber: | 9195676121 | ||||||||
| Practice Location | |||||||||
| Address1: | 781 AVENT FERRY RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275407776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195676120 | ||||||||
| FaxNumber: | 9195676121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9601332 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 891024T | 05 | NC | MEDICAID |