Provider Demographics
NPI:1619988607
Name:BOTROS & POLLOCK, PA
Entity Type:Organization
Organization Name:BOTROS & POLLOCK, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-762-0234
Mailing Address - Street 1:1625 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7405
Mailing Address - Country:US
Mailing Address - Phone:910-762-0234
Mailing Address - Fax:910-762-7042
Practice Address - Street 1:1625 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7405
Practice Address - Country:US
Practice Address - Phone:910-762-0234
Practice Address - Fax:910-762-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001528Medicaid
NC890189RMedicaid
NCC85709Medicare UPIN
NC2318608Medicare PIN
NCC80996Medicare UPIN