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General NPI Number Information
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NPI Number | 1003180274
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Entity Type | Organization
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Legal Business Name | CHELTENHAM CLINICAL SERVICES, PC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 2435 LYNN RD SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27612-6755
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Country | US
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Telephone | 919-438-7396
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Fax |
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Provider Business Mailing Address
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Address Line | 628 DODDINGTON DR
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City | ROLESVILLE
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State | NC
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Zip | 27571-9700
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Country | US
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Telephone | 919-438-7396
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Fax | 919-761-8693
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. MARK CHELTENHAM
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Credential | MD
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Telephone | 919-438-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 181013
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License Number State | NC
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