Healthcare Provider Details

I. General information

NPI: 1790817963
Provider Name (Legal Business Name): CARY PEDIATRIC CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CRESCENT GREEN DR
CARY NC
27518-8101
US

IV. Provider business mailing address

1001 CRESCENT GREEN DR
CARY NC
27518-8101
US

V. Phone/Fax

Practice location:
  • Phone: 919-467-3211
  • Fax: 919-467-5315
Mailing address:
  • Phone: 919-467-3211
  • Fax: 919-467-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. JULIE B WILLIAMS
Title or Position: BUSINESS OFFICE PERSONNEL
Credential:
Phone: 919-467-1057