MEDICARE: PEDIATRIC POSSIBILITIES, P.A.

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017KA	OTHER	NC	BCBS PROVIDER GROUPNUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366534026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC POSSIBILITIES, P.A.

Provider Business Mailing Address
First Line	:	7209 CREEDMOOR RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1695
Country	:	US
Telephone Number	:	919-844-1100
Fax Number	:	919-844-1102

Provider Business Practice Location Address
First Line	:	7209 CREEDMOOR RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1695
Country	:	US
Telephone Number	:	919-844-1100
Fax Number	:	919-844-1102

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. DAWN M ROHLIK
Credential	:	BS, OTR/L
Telephone Number	:	919-844-1100

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/22/2020

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