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General NPI Number Information
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NPI Number | 1114027588
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Entity Type | Individual
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Provider Name | MARK PHILIP CHELTENHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/07/2023
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Provider Practice Location 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 | 919-761-8693
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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 | 919-761-8693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2007-00205
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD425741
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License Number State | PA
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