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General NPI Number Information
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NPI Number | 1295217008
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Entity Type | Organization
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Legal Business Name | CENTRICITY CARE, PLLC
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 2417 BRYARTON WOODS DR
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City | RALEIGH
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State | NC
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Zip | 27606-4022
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Country | US
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Telephone | 571-239-1139
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Fax |
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Provider Business Mailing Address
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Address Line | 2417 BRYARTON WOODS DR
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City | RALEIGH
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State | NC
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Zip | 27606-4022
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Country | US
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Telephone | 571-239-1139
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE ADMINISTRATOR
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Name | MR. KASHIF MALIK
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Credential |
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Telephone | 571-239-1139
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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 | 2018-01932
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License Number State | NC
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