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General NPI Number Information
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NPI Number | 1932521630
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Entity Type | Organization
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Legal Business Name | COVENANT PEDIATRICS PA
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 101 E MATTHEWS ST SUITE 800
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City | MATTHEWS
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State | NC
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Zip | 28105-4866
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Country | US
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Telephone | 704-321-5700
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Fax | 704-321-5701
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Provider Business Mailing Address
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Address Line | 101 E MATTHEWS ST SUITE 800
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City | MATTHEWS
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State | NC
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Zip | 28105-4866
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Country | US
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Telephone | 704-321-5700
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Fax | 704-321-5701
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONIA OGECHI EMEZIE
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Credential | M.D.
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Telephone | 704-321-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 200301456
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 200301456
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License Number State | NC
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