| Central Pediatrics & Internal Medicine, Pa | |
|
3040 Eastway Drive Suite A Charlotte NC 28205 | |
| (980) 237-9130 | |
| (980) 237-8082 |
| Full Name | Central Pediatrics & Internal Medicine, Pa |
|---|---|
| Speciality | Pediatrics |
| Location | 3040 Eastway Drive Suite A, Charlotte, North Carolina |
| Authorized Official Name and Position | Julius Tokunboh (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7048177560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Pediatrics & Internal Medicine, Pa 3040 Eastway Drive Suite A Charlotte NC 28205 Ph: (980) 237-9130 | Central Pediatrics & Internal Medicine, Pa 3040 Eastway Drive Suite A Charlotte NC 28205 Ph: (980) 237-9130 |
| NPI Number | 1871977249 |
|---|---|
| Provider Enumeration Date | 07/16/2015 |
| Last Update Date | 03/09/2017 |
| Medicare PECOS PAC ID | 8820379209 |
|---|---|
| Medicare Enrollment ID | O20161222001076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871977249 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 211850 (North Carolina) | Secondary |
| 208000000X | Pediatrics | 211850 (North Carolina) | Primary |
| Provider Name | Julius Kehinde Tokunboh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952410110 PECOS PAC ID: 8426024001 Enrollment ID: I20040910000199 |
| Provider Name | Elizabeth Mary Nista Mellott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164923223 PECOS PAC ID: 3678838794 Enrollment ID: I20180521000763 |
| Provider Name | Ratna Acharya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235740945 PECOS PAC ID: 7719395342 Enrollment ID: I20210421000844 |
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