Provider Demographics
NPI:1972040848
Name:PHYCINITY PLLC
Entity Type:Organization
Organization Name:PHYCINITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:LEONEL
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-373-3636
Mailing Address - Street 1:450 CARTHAGE ST UNIT 158
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-5106
Mailing Address - Country:US
Mailing Address - Phone:919-373-3636
Mailing Address - Fax:919-867-3493
Practice Address - Street 1:2277 NC 24-87
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-6687
Practice Address - Country:US
Practice Address - Phone:919-373-3636
Practice Address - Fax:919-867-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC216754208000000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty