Healthcare Provider Details

I. General information

NPI: 1982904223
Provider Name (Legal Business Name): WASHINGTON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BROWN ST
WASHINGTON NC
27889-4671
US

IV. Provider business mailing address

1206 BROWN ST
WASHINGTON NC
27889-4671
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-4134
  • Fax: 252-946-2432
Mailing address:
  • Phone: 252-946-4134
  • Fax: 252-946-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSEL C COOK
Title or Position: PRESIDENT
Credential:
Phone: 252-946-4134