MEDICARE: DR. HILLARY BLAIR LIKEN M.D.

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	2020-02636	NC

General Provider Information

NPI Number	:	1821525122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HILLARY BLAIR LIKEN M.D.

Provider Business Mailing Address
First Line	:	1124 TONSLER DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-2300
Country	:	US
Telephone Number	:	706-340-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 CREEKSTONE DR STE 300
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-0016
Country	:	US
Telephone Number	:	919-613-0413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	08/30/2024

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