Provider Demographics
NPI:1205206604
Name:CAROLINA DEVELOPMENTAL PEDIATRICS PA
Entity type:Organization
Organization Name:CAROLINA DEVELOPMENTAL PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-362-5406
Mailing Address - Street 1:1001 W WILLIAMS ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3978
Mailing Address - Country:US
Mailing Address - Phone:919-362-5406
Mailing Address - Fax:919-362-5409
Practice Address - Street 1:1001 W WILLIAMS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3978
Practice Address - Country:US
Practice Address - Phone:919-362-5406
Practice Address - Fax:919-362-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001005792080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285HOtherBCBS
NC891285HMedicaid
F22730Medicare UPIN