Provider Demographics
NPI:1205967460
Name:MCM PEDIATRIC AND ADOLESCENT HOME PRACTICE, P.A.
Entity type:Organization
Organization Name:MCM PEDIATRIC AND ADOLESCENT HOME PRACTICE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MERGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-997-7180
Mailing Address - Street 1:711 S LONG DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4315
Mailing Address - Country:US
Mailing Address - Phone:910-997-7180
Mailing Address - Fax:910-997-3830
Practice Address - Street 1:711 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4315
Practice Address - Country:US
Practice Address - Phone:910-997-7180
Practice Address - Fax:910-997-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-018702080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty