Healthcare Provider Details

I. General information

NPI: 1619920048
Provider Name (Legal Business Name): ESSEX PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 BARRETT DR SUITE 101
RALEIGH NC
27609-6623
US

IV. Provider business mailing address

4016 BARRETT DR SUITE 101
RALEIGH NC
27609-6623
US

V. Phone/Fax

Practice location:
  • Phone: 919-751-9120
  • Fax: 919-751-9170
Mailing address:
  • Phone: 919-751-9120
  • Fax: 919-751-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERINE IBRAHIM
Title or Position: OWNER
Credential: M.D.
Phone: 919-751-9120