Provider Demographics
NPI:1245245034
Name:SUNRISE PEDIATRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:SUNRISE PEDIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MURNANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-788-0505
Mailing Address - Street 1:3909 SUNSET RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6667
Mailing Address - Country:US
Mailing Address - Phone:919-788-0505
Mailing Address - Fax:919-788-0519
Practice Address - Street 1:3909 SUNSET RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6667
Practice Address - Country:US
Practice Address - Phone:919-788-0505
Practice Address - Fax:919-788-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011FCOtherBLUE CROSS BLUE SHIELD
NC89011FCMedicaid