Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 200200427 | NC |
Y | 208600000X | Surgeon | 200200427 | NC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 200200427 | NC |
NPI | 1063412377 |
---|---|
Provider Name | Dr. Peter Conrad Ng |
First Address | Raleigh, NC 27609-7327 |
Second Address | Raleigh, NC 27609-7327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 12/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1318M | BCBS-NC (01) | NC |
891318M | (05) | NC |
H58023 | (02) |