Provider Demographics
NPI:1528195906
Name:PAMLICO PEDIATRICS, PC
Entity Type:Organization
Organization Name:PAMLICO PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-745-2070
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515
Mailing Address - Country:US
Mailing Address - Phone:252-745-2070
Mailing Address - Fax:252-745-2202
Practice Address - Street 1:13531 HWY 55 WEST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NC
Practice Address - Zip Code:28509
Practice Address - Country:US
Practice Address - Phone:252-745-2070
Practice Address - Fax:252-745-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0039010173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012G9OtherBCBSNC
NC89012G9Medicaid
NC012G9OtherBCBSNC