Provider Demographics
NPI:1326678236
Name:PELICAN FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:PELICAN FAMILY MEDICINE, P.A.
Other - Org Name:PELICAN FAMILY MEDICINE AT PHYSICIANS DRIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SAMUEL THOMAS
Authorized Official - Last Name:ARMITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-792-1001
Mailing Address - Street 1:5429 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6513
Mailing Address - Country:US
Mailing Address - Phone:910-792-1001
Mailing Address - Fax:910-792-1004
Practice Address - Street 1:1602 PHYSICIANS DR STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7350
Practice Address - Country:US
Practice Address - Phone:910-762-8077
Practice Address - Fax:910-762-2760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PELICAN FAMILY MEDICINE, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty