Provider Demographics
NPI:1598960262
Name:VILLAGE PEDIATRICS
Entity Type:Organization
Organization Name:VILLAGE PEDIATRICS
Other - Org Name:VILLAGE PEDIATRICS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-469-1989
Mailing Address - Street 1:1100 NW MAYNARD RD
Mailing Address - Street 2:UNIT 110
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8706
Mailing Address - Country:US
Mailing Address - Phone:919-469-1989
Mailing Address - Fax:919-469-2191
Practice Address - Street 1:1100 NW MAYNARD RD
Practice Address - Street 2:UNIT 110
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8706
Practice Address - Country:US
Practice Address - Phone:919-469-1989
Practice Address - Fax:919-469-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954585Medicaid