Provider Demographics
NPI:1841627692
Name:CREEDMOOR CENTRE ENDOCRINOLOGY PA
Entity type:Organization
Organization Name:CREEDMOOR CENTRE ENDOCRINOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARREN-ULANCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-845-3332
Mailing Address - Street 1:8340 BANDFORD WAY
Mailing Address - Street 2:SUITE 001
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2755
Mailing Address - Country:US
Mailing Address - Phone:919-845-3332
Mailing Address - Fax:919-845-3395
Practice Address - Street 1:8340 BANDFORD WAY
Practice Address - Street 2:SUITE 001
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2755
Practice Address - Country:US
Practice Address - Phone:919-845-3332
Practice Address - Fax:919-845-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905118Medicaid
NC2058476Medicare UPIN