Provider Demographics
NPI:1669480042
Name:PELICAN FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:PELICAN FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:ARMITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-792-1001
Mailing Address - Street 1:5429 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6513
Mailing Address - Country:US
Mailing Address - Phone:910-792-1001
Mailing Address - Fax:910-792-1004
Practice Address - Street 1:5429 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6513
Practice Address - Country:US
Practice Address - Phone:910-792-1001
Practice Address - Fax:910-792-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130GRMedicaid
NC2294885Medicare ID - Type Unspecified
NCH50815Medicare UPIN