Healthcare Provider Details

I. General information

NPI: 1841627692
Provider Name (Legal Business Name): CREEDMOOR CENTRE ENDOCRINOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 BANDFORD WAY SUITE 001
RALEIGH NC
27615-2755
US

IV. Provider business mailing address

8340 BANDFORD WAY STE 1
RALEIGH NC
27615-2755
US

V. Phone/Fax

Practice location:
  • Phone: 919-845-3332
  • Fax: 919-845-3395
Mailing address:
  • Phone: 919-845-3332
  • Fax: 888-714-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2006-01609
License Number StateNC

VIII. Authorized Official

Name: BARBARA JO ULANCH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-845-3332