MEDICARE: PELICAN FAMILY MEDICINE AT MONKEY JUNCTION

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	207Q00000X	Family Medicine Physician	200101001	NC

General Provider Information

NPI Number	:	1588811285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELICAN FAMILY MEDICINE AT MONKEY JUNCTION

Provider Business Mailing Address
First Line	:	5429 WRIGHTSVILLE AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6513
Country	:	US
Telephone Number	:	910-799-7078
Fax Number	:

Provider Business Practice Location Address
First Line	:	5905 CAROLINA BEACH RD STE 8
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2760
Country	:	US
Telephone Number	:	910-792-1001
Fax Number	:	910-792-1004

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	MARK SAMUEL THOMAS ARMITAGE
Credential	:	MD
Telephone Number	:	910-332-7900

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/29/2021

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