Healthcare Provider Details

I. General information

NPI: 1700057486
Provider Name (Legal Business Name): KIDS FIRST PEDIATRICS OF RALEIGH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 WAKE FOREST RD STE 300
RALEIGH NC
27609-2508
US

IV. Provider business mailing address

4109 WAKE FOREST RD STE 300
RALEIGH NC
27609-2508
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-3478
  • Fax: 919-250-6272
Mailing address:
  • Phone: 919-250-3478
  • Fax: 919-250-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SELAM BULLOCK
Title or Position: CEO
Credential: MD
Phone: 919-250-3478