Provider Demographics
NPI:1356439566
Name:RAINBOW PEDIATRICS OF FAYETTEVILLE
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS OF FAYETTEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:910-486-5437
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:910-486-5437
Mailing Address - Fax:910-486-0011
Practice Address - Street 1:1327 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5531
Practice Address - Country:US
Practice Address - Phone:910-486-5437
Practice Address - Fax:910-486-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-06-19
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
NCG84050Medicare UPIN