Provider Demographics
NPI:1083866370
Name:APEX PEDIATRIC AND ADOLESCENT CLINIC,P.A
Entity Type:Organization
Organization Name:APEX PEDIATRIC AND ADOLESCENT CLINIC,P.A
Other - Org Name:CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARATH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOMMARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1919-858-0600
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27512-0310
Mailing Address - Country:US
Mailing Address - Phone:919-858-0600
Mailing Address - Fax:919-858-0540
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-858-0600
Practice Address - Fax:919-858-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00317261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care