=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821224197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLSBOROUGH PEDIATRIC AND ADOLESCENT MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2009
-----------------------------------------------------
Last Update Date | 06/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 CORPORATE DR SUITE 401
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27278-8535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-245-3344
-----------------------------------------------------
Fax | 919-245-3308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 CORPORATE DR SUITE 401
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27278-8535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-245-3344
-----------------------------------------------------
Fax | 919-245-3308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. MELISSA ROBIN CLEPPER-FAITH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 919-245-3344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 94-00754
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------