Healthcare Provider Details

I. General information

NPI: 1760611487
Provider Name (Legal Business Name): GRETCHEN MARIA INKUMSAH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 FALLS OF NEUSE RD STE 401
RALEIGH NC
27615-5325
US

IV. Provider business mailing address

5045 NC HIGHWAY 42 W # B
WILSON NC
27893-7731
US

V. Phone/Fax

Practice location:
  • Phone: 919-373-3636
  • Fax:
Mailing address:
  • Phone: 919-744-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012-01846
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: