Basic Information
Provider Information
NPI: 1760424204
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BINNEY
FirstName: JEFFREY
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 205 PAGE RD
Address2:  
City: PINEHURST
State: NC
PostalCode: 283748749
CountryCode: US
TelephoneNumber: 9102955511
FaxNumber: 9104201609
Practice Location
Address1: 15 REGIONAL DR
Address2:  
City: PINEHURST
State: NC
PostalCode: 283748850
CountryCode: US
TelephoneNumber: 9102554400
FaxNumber: 9104201609
Other Information
ProviderEnumerationDate: 06/11/2006
LastUpdateDate: 03/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X2003-01327NCY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
89136CR05NC MEDICAID
FH203018501NCFIRSTCAROLINACARE PROV#OTHER
N0132401SCSC MEDICAID PROVIDER#OTHER
P0008132801NCPALMETTO GBA PROVIDER#OTHER
040398301NCEVERCAREOTHER
D249601NCMEDCOST PROVIDER#OTHER
136CR01NCBC/BS NC PROVIDER#OTHER


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