Provider Demographics
NPI:1740673946
Name:RAINBOW KIDS PEDIATRICS
Entity type:Organization
Organization Name:RAINBOW KIDS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:SANATRA
Authorized Official - Last Name:FAISON-ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-435-1099
Mailing Address - Street 1:853 DURHAM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8793
Mailing Address - Country:US
Mailing Address - Phone:919-435-1099
Mailing Address - Fax:919-435-1130
Practice Address - Street 1:853 DURHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8793
Practice Address - Country:US
Practice Address - Phone:919-435-1099
Practice Address - Fax:919-435-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC229108OtherUNITED
NC8912588Medicaid
NC331532OtherWELLPATH
NC1258XOtherBCBS
NC1258XOtherBCBS