Provider Demographics
NPI:1174532972
Name:CMG OF NORTH CAROLINA, INC.
Entity type:Organization
Organization Name:CMG OF NORTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-668-8565
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7017
Mailing Address - Fax:757-668-8929
Practice Address - Street 1:1735 CITY CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8960
Practice Address - Country:US
Practice Address - Phone:252-338-2155
Practice Address - Fax:252-338-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty