Provider Demographics
NPI:1831279215
Name:CROSS CREEK PEDIATRICS
Entity Type:Organization
Organization Name:CROSS CREEK PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:APPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-484-8009
Mailing Address - Street 1:2035 VALLEYGATE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3688
Mailing Address - Country:US
Mailing Address - Phone:910-484-8009
Mailing Address - Fax:910-484-2205
Practice Address - Street 1:2035 VALLEYGATE DR
Practice Address - Street 2:STE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-484-8009
Practice Address - Fax:910-484-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH19327Medicare UPIN
NCF45766Medicare UPIN