1598960262 NPI number — VILLAGE PEDIATRICS

Table of content: (NPI 1598960262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598960262 NPI number — VILLAGE PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE PEDIATRICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VILLAGE PEDIATRICS PLLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598960262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 NW MAYNARD RD
Provider Second Line Business Mailing Address:
UNIT 110
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27513-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-469-1989
Provider Business Mailing Address Fax Number:
919-469-2191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 NW MAYNARD RD
Provider Second Line Business Practice Location Address:
UNIT 110
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27513-8706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-469-1989
Provider Business Practice Location Address Fax Number:
919-469-2191
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASSARO
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
919-469-1989

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8954585 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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