Provider Demographics
NPI:1730154857
Name:PEDIATRIC PARTNERS PA
Entity type:Organization
Organization Name:PEDIATRIC PARTNERS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BRENNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-9555
Mailing Address - Street 1:5816 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2310
Mailing Address - Country:US
Mailing Address - Phone:919-787-9555
Mailing Address - Fax:919-510-5111
Practice Address - Street 1:5816 CREEDMOOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:919-787-9555
Practice Address - Fax:919-510-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82961Medicare UPIN