Provider Demographics
NPI:1932438686
Name:CARMEL PEDIATRICS, PA
Entity Type:Organization
Organization Name:CARMEL PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CARMEL PEDIATRICS, PA
Authorized Official - Prefix:DR
Authorized Official - First Name:ADA
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-752-2000
Mailing Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3174
Mailing Address - Country:US
Mailing Address - Phone:704-752-2000
Mailing Address - Fax:704-752-1212
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3174
Practice Address - Country:US
Practice Address - Phone:704-752-2000
Practice Address - Fax:704-752-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93-00080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890196TMedicaid