Provider Demographics
NPI:1710229570
Name:CAROLINA PEDIATRICS OF HAMPSTEAD
Entity Type:Organization
Organization Name:CAROLINA PEDIATRICS OF HAMPSTEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-763-8183
Mailing Address - Street 1:STREET 15444 HWY 17NORTH
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0000
Mailing Address - Country:US
Mailing Address - Phone:910-777-2013
Mailing Address - Fax:910-777-2015
Practice Address - Street 1:715 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7406
Practice Address - Country:US
Practice Address - Phone:910-763-8183
Practice Address - Fax:910-777-2015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA PEDIATRICS OF WILMINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00000000OtherPENDING MPN