Provider Demographics
NPI:1164655932
Name:RAINBOW PEDIATRICS OF HOPE MILLS
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS OF HOPE MILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANER
Authorized Official - Middle Name:
Authorized Official - Last Name:ESENSOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-426-5430
Mailing Address - Street 1:PO BOX 87407
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7407
Mailing Address - Country:US
Mailing Address - Phone:910-426-5430
Mailing Address - Fax:910-426-5435
Practice Address - Street 1:4469 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-9546
Practice Address - Country:US
Practice Address - Phone:910-426-5430
Practice Address - Fax:910-426-5435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAINBOW PEDIATRICS OF FAYETTEVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907969Medicaid