NORTHLAKE PEDIATRIC CARE PA (NPI# 1083729701) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083729701 |
| Entity Type | Organization |
| Organization Name | NORTHLAKE PEDIATRIC CARE PA |
| Practice Address |
2117 Simonton Rd Suite 402 Statesville NC 28625-8206 |
| Practice Telephone | 7048712323 |
| Practice Fax Number | 8036192149 |
| Mailing Telephone | 7048712323 |
| Mailing Fax Number | 8036192149 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2013-05-30 |
| Authorized Official Name | MICHAEL BORJA (OWNER) |
| Authorized Official Telephone | 7048712323 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CLIA ID | 34D1014813 | 01 | |
| NC | 5918872 | 05 | |
| NC | BCBS OF NC | 1002P | 01 |
| Street Address |
2117 SIMONTON RD SUITE 402 |
| City | STATESVILLE |
| State | NC |
| Zip Code | 28625-8206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861489759 | Willie Roscoe Whitaker | Internal Medicine | 2117 Simonton Rd, Suite 102, Statesville, NC 28625-8403 | 2005-10-05 |
| 1972882140 | Perry S Justice Jr Dds Pa | Dentist | 2117 Simonton Rd, Suite 403, Statesville, NC 28625-8206 | 2011-08-05 |
| 1851421515 | Perry Stephen Justice Jr. | Dentist | 2117 Simonton Rd, Suite 403, Statesville, NC 28625-8403 | 2007-03-06 |
| 1023125861 | Michael Borja | Specialist | 2117 Simonton Rd, Suite 402, Statesville, NC 28625-8206 | 2006-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714163 | Sandra Lourdes Mayta | Counselor | 1450 Fern Creek Drive, Statesville, NC 28625 | 2020-03-05 |
| 1023643582 | Youngchi Chang Dds Pllc | Dentist | 964 Glenway Ave Ste A, Statesville, NC 28625 | 2020-03-05 |
| 1538799200 | Nicole-marie Blischak | Dentist | 964 Glenway Dr, Ste A, Statesville, NC 28625 | 2020-01-22 |
| 1013575257 | Sherry Neilson | Registered Nurse | 524 Signal Hill Rd, Statesville, NC 28625 | 2019-06-03 |
| 1770904328 | Elinor Kyle Tyner | Counselor | 1206 Museum Road, Statesville, NC 28625 | 2013-12-30 |
| 1982031001 | Tamiko Bradley | Counselor | 524 Signal Hill Dr Ext, Statesville, NC 28625 | 2013-10-03 |
| 1487932505 | Nicole Weisner Winecoff | Advanced Practice Midwife | 1420 Fern Creek Drive, Statesville, NC 28625 | 2011-07-22 |
| 1538461967 | Bethany J Sprague | Nurse Practitioner | 2632 Fines Creek Dr, Statesville, NC 28625 | 2010-11-17 |
| 1477789147 | Greenbriar Primary Care, Pa | Nurse Practitioner | 308-c Mocksville Highway, Statesville, NC 28625 | 2009-06-08 |
| 1619122538 | Phasebdevelopment | Substance Abuse Rehabilitation Facility | 113 Bethany Rd, Statesville, NC 28625 | 2008-11-19 |
| Find all providers in zip 28625 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700112612 | Uma Periyanayagam | Pediatrics | 1410 Fern Creek Dr, Statesville, NC 28625-9376 | 2009-10-28 |
| 1083784862 | Jon R. Hutchinson | Pediatrics | 558 Kitchings Dr, Statesville, NC 28677-3588 | 2006-11-08 |
| 1245256130 | Geoffrey Alan Abell | Pediatrics | 925 Thomas St Ste A, Statesville, NC 28677-3484 | 2006-07-14 |
| 1487619185 | Statesville Childrens Clinic Pa | Pediatrics | 925 A Thomas St, Statesville, NC 28677-3484 | 2006-04-18 |
| 1265424766 | Walter C Gessler | Pediatrics | 129 Sherlock Dr, Statesville, NC 28625-1916 | 2005-08-19 |
| 1912999681 | Ralph L Bentley | Pediatrics | 1022 Shelton Ave, Statesville, NC 28677-6826 | 2005-08-18 |
| 1992278287 | Piedmont Healthcare, Pa | Pediatrics | 129 Sherlock Dr, Statesville, NC 28625-1916 | 2019-01-09 |
| 1548733108 | Piedmont Healthcare, Pa | Pediatrics | 558 Kitchings Dr, Statesville, NC 28677-3588 | 2019-01-07 |
| 1902151152 | Ali Nasir Chhotani | Pediatrics | 1410 Fern Creek Dr, Statesville, NC 28625-9376 | 2012-07-13 |
| 1336403211 | Tara Moon | Pediatrics | 1410 Fern Creek Dr, Statesville, NC 28625-9376 | 2012-06-26 |
| Find all providers in STATESVILLE | ||||
| City | STATESVILLE |
| Zip Code | 28625 |
Please comment or provide details below to improve the information on NORTHLAKE PEDIATRIC CARE PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.