MEDICARE: REGIONAL PEDIATRIC ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306834510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL PEDIATRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	4022 FREEDOM LAKE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2156
Country	:	US
Telephone Number	:	919-477-2202
Fax Number	:	919-471-2270

Provider Business Practice Location Address
First Line	:	4022 FREEDOM LAKE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2156
Country	:	US
Telephone Number	:	919-477-2202
Fax Number	:	919-471-2270

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. BRIDGET G MUSSLER
Credential	:
Telephone Number	:	919-313-1018

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	01/27/2011

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