Healthcare Provider Details

I. General information

NPI: 1114027588
Provider Name (Legal Business Name): MARK PHILIP CHELTENHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 FALSTAFF RD
RALEIGH NC
27610-1812
US

IV. Provider business mailing address

3020 FALSTAFF RD
RALEIGH NC
27610-1813
US

V. Phone/Fax

Practice location:
  • Phone: 919-761-8693
  • Fax:
Mailing address:
  • Phone: 919-341-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD425741
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2007-00205
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: