Provider Demographics
NPI:1821214552
Name:HALIFAX PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:HALIFAX PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-537-1400
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:529 BECKER DRIVE
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0787
Mailing Address - Country:US
Mailing Address - Phone:252-537-1400
Mailing Address - Fax:252-537-4936
Practice Address - Street 1:529 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3303
Practice Address - Country:US
Practice Address - Phone:252-537-1400
Practice Address - Fax:252-537-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28419261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF45889Medicare UPIN
NC2343505Medicare ID - Type Unspecified