PEDIATRIC PRACTICE (NPI# 1396907903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396907903 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC PRACTICE |
| Other Organization Name | CAPE FEAR VALLEY PEDIATRIC ENDOCRINOLOGY |
| Practice Address |
101 Robeson St Suite 405 Fayetteville NC 28301-5552 |
| Mailing Address |
Po Box 41209 Fayetteville NC 28309-1209 |
| Practice Telephone | 9106091688 |
| Practice Fax Number | 9103216254 |
| Mailing Telephone | 9106096448 |
| Mailing Fax Number | 9106095070 |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-06-26 |
| Authorized Official Name | MR. MICHAEL NAGOWSKI (CEO) |
| Authorized Official Telephone | 9106096700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
H0213 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | PENDING | 05 |
| Other Name | Type Code |
|---|---|
| Cape Fear Valley Pediatric Endocrinology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538221171 | Pediatric Practice | Pediatrics | 127 Palisade Ave, Jersey City, NJ 07306-1101 | 2006-12-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PEDIATRIC PRACTICE ADMINISTRATION, LLC | 14279 S Glen Oak Rd, Oregon City, OR 97045 |
| New York State Corporations | PEDIATRIC PRACTICE AND CONSULTING, PLLC | 346 Taylor Road, Honeoye Falls, Ny 14472 |
| System for Award Management (SAM) Entities | PEDIATRIC PRACTICE ASSOCIATION | 201 E 2nd St, Rio Grande City, TX 78582-3803 |
| Street Address |
101 ROBESON ST SUITE 405 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28301-5552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285637397 | Leon E Dantzler | Internal Medicine | 101 Robeson St, Suite 300, Fayetteville, NC 28301-5552 | 2005-05-23 |
| 1962014803 | Paige Greene | Pharmacist | 101 Robeson St, Fayetteville, NC 28301-5552 | 2020-08-21 |
| 1013536234 | Ashley Stone | Health Educator | 101 Robeson St, Fayetteville, NC 28301-5552 | 2020-04-09 |
| 1508242280 | Kelly Fynboe | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2015-08-05 |
| 1720412968 | Autumn Lee Mittleider | Pharmacist | 101 Robeson St, Ste 202, Fayetteville, NC 28301-5552 | 2013-08-23 |
| 1447695994 | Erik Wiglama | Internal Medicine | 101 Robeson St, Suite 300, Fayetteville, NC 28301-5552 | 2013-05-09 |
| 1588952329 | John Pasztor | Dietitian, Registered | 101 Robeson St, Suite 410, Fayetteville, NC 28301-5552 | 2011-07-14 |
| 1497045496 | Nduche Chika Onyeaso | Internal Medicine | 101 Robeson St, Suite 405, Fayetteville, NC 28301-5552 | 2011-04-11 |
| 1982900247 | Samantha Moore Paquette | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2011-02-03 |
| 1386970572 | Jamie Dickerhoff | Nurse Practitioner | 101 Robeson St, Suite 410, Fayetteville, NC 28301-5552 | 2009-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726219 | Jenna Michelle Odneal | Behavior Technician | 16915 Liverpool Pkwy. Suite B., Cornelius, NC 28301 | 2020-10-02 |
| 1790390094 | Jessica Shellman | Counselor | 408 Person St. Ste 103, Fayetteville, NC 28301 | 2020-09-14 |
| 1487205951 | Martha K Richardson | Technician | 720 Teachers Dr, Fayetteville, NC 28301 | 2019-09-25 |
| 1013568161 | Angela Rena Locklear | Counselor | 211 Lamon St, Fayeteville, NC 28301 | 2019-09-20 |
| 1619535747 | Teresa Wilson | Contractor | 1417 Canyionland Ct, Apt 209, Fayetteville, NC 28301 | 2019-06-04 |
| 1912461815 | Catherine Stevenson Nwogalanya | Community Health Worker | 1103 Hillsboro St., Fayetteville, NC 28301 | 2019-01-24 |
| 1811443187 | Michael Carroll | Counselor | 308 Peterson Place, Fayetteville, NC 28301 | 2016-08-28 |
| 1023499886 | Latifa Fedai | Nurse Practitioner | 380 Person Street, Fayettevill, NC 28301 | 2015-06-17 |
| 1265868939 | Aci Support Specialists | Community/Behavioral Health | 1725 Venna Drive, Fayetteville, NC 28301 | 2013-09-25 |
| 1871929547 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 2820 Copenhagen Drive, Fayetteville, NC 28301 | 2013-09-25 |
| Find all providers in zip 28301 | ||||
| Taxonomy Code | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| 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/certification - 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 |
|---|---|---|---|---|
| 1073179867 | Novant Medical Group, Inc. | Pediatrics | 311 Coddle Market Dr Nw Ste 200, Concord, NC 28027-2432 | 2019-05-16 |
| 1124202114 | Jennifer Rachel Law | Pediatrics | 3341 Mbrb Cb 7039, University of North Carolina, Chapel Hill, NC 27599-0001 | 2007-12-26 |
| 1245443126 | Nina Jain | Pediatrics | Unc, Cb # 7039, 3341 Biomolecular (mbrb), Chapel Hill, NC 27599-0001 | 2007-05-08 |
| 1376696062 | Cmc-northeast, Inc | Pediatrics | 16623 Birkdale Cmns Pkwy, Suite 110, Ne Pediatric Endo, Huntersville, NC 28078-5621 | 2007-01-18 |
| 1801825914 | Lisa Houchin | Pediatrics | 4501 Cameron Valley Pkwy, Ste 200, Charlotte, NC 28211-4297 | 2006-07-01 |
| 1437141611 | Maria Janae Henwood-finley | Pediatrics | 2150 Herbert Ct, Ecu Pediatric Specialty Clinic, Greenville, NC 27834-3736 | 2005-08-16 |
| 1265097695 | Wakemed Specialists Group, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1386164051 | Novant Medical Group, Inc | Pediatrics | 201 Queens Rd, Charlotte, NC 28204-3217 | 2017-06-23 |
| 1518378553 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2014-05-13 |
| 1902233380 | The Charlotte-mecklenburg Hospital Authority | Pediatrics | 9625 Northcross Center Ct, Ste 102c, Huntersville, NC 28078-7348 | 2013-10-01 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 28301 |
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| 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.