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General NPI Number Information
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NPI Number | 1194966903
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Entity Type | Organization
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Legal Business Name | FIRST PEDIATRIC CARE CENTER, P.A.
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 2644 COURT DRIVE
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City | GASTONIA
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State | NC
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Zip | 28054-1449
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Country | US
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Telephone | 704-868-3664
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Fax | 704-868-3665
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Provider Business Mailing Address
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Address Line | 2644 COURT DRIVE
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City | GASTONIA
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State | NC
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Zip | 28054-1449
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Country | US
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Telephone | 704-868-3664
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Fax | 704-868-3665
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARGARET LUBEGA
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Credential | M.D.
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Telephone | 704-868-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 119285
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License Number State | NC
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