Provider Demographics
NPI:1306834510
Name:REGIONAL PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:REGIONAL PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUSSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-313-1018
Mailing Address - Street 1:4022 FREEDOM LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2156
Mailing Address - Country:US
Mailing Address - Phone:919-477-2202
Mailing Address - Fax:919-471-2270
Practice Address - Street 1:4022 FREEDOM LAKE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2156
Practice Address - Country:US
Practice Address - Phone:919-477-2202
Practice Address - Fax:919-471-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02065Medicaid