Healthcare Provider Details

I. General information

NPI: 1205804986
Provider Name (Legal Business Name): VINCENT KILMER CHEEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/07/2023
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
KENANSVILLE NC
28349-8801
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-2774
  • Fax:
Mailing address:
  • Phone: 984-215-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28404
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101041661
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101041661
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28404
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: