Healthcare Provider Details

I. General information

NPI: 1730154857
Provider Name (Legal Business Name): PEDIATRIC PARTNERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 CREEDMOOR RD SUITE 104
RALEIGH NC
27612-2310
US

IV. Provider business mailing address

5816 CREEDMOOR RD
RALEIGH NC
27612-2310
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-9555
  • Fax: 919-510-5111
Mailing address:
  • Phone: 919-787-9555
  • Fax: 919-510-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27129
License Number StateNC

VIII. Authorized Official

Name: DR. TERRY RICHARD BRENNEMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-787-9555