Provider Demographics
NPI:1720364649
Name:DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Other - Org Name:MARIA PARHAM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-436-1674
Mailing Address - Street 1:120 CHARLES ROLLINS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-436-0440
Mailing Address - Fax:252-436-0281
Practice Address - Street 1:511 RUIN CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5919
Practice Address - Country:US
Practice Address - Phone:252-436-0440
Practice Address - Fax:252-436-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty