FAITH PEDIATRICS AND ADOLESCENT MEDICINE INC. NPI 1023077211

NPI Information

NPI: 1023077211
Provider Name: FAITH PEDIATRICS AND ADOLESCENT MEDICINE INC.
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 34D0862497

Address:
3350 SIX FORKS RD
RALEIGH, NC
ZIP 27609
Phone: (919) 881-9440
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FAITH PEDIATRICS AND ADOLESCENT MEDICINE INC. is an adolescent medicine pediatrics in Raleigh, NC. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. FAITH PEDIATRICS AND ADOLESCENT MEDICINE INC. NPI is 1023077211. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3350 SIX FORKS RD
RALEIGH, NC
ZIP 27609-233
Phone: (919) 881-9440
Fax: (919) 881-9465

The provider's authorized official is Connell Covington .
The authorized official title is Physician and has the following contact phone number (919) 881-9440.

The CLIA number assigned to this NPI record is 34D0862497 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/17/2006 and was last updated on 4/13/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	Yes
2	363A00000X	Physician Assistant		No
3	363LF0000X	Nurse Practitioner	Family	No
4	363LP0200X	Nurse Practitioner	Pediatrics	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7901770	MEDICAID	NORTH CAROLINA
2	01770	OTHER	NORTH CAROLINA	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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