Provider Demographics
NPI:1508318114
Name:SENTINEL PRIMARY CARE
Entity Type:Organization
Organization Name:SENTINEL PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-797-0550
Mailing Address - Street 1:10208 CERNY ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7884
Mailing Address - Country:US
Mailing Address - Phone:919-797-0550
Mailing Address - Fax:
Practice Address - Street 1:10208 CERNY ST
Practice Address - Street 2:SUITE 308
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7884
Practice Address - Country:US
Practice Address - Phone:919-797-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMD 2006-738261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care