Organization
CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH ELLEN TILT M.D. (PRESIDENT)
(704) 799-2878
Entity
Organization
Contact information
Practice address
136 GATEWAY BLVD STE A, MOORESVILLE, NC 28117-5608
(704) 799-2878
(704) 799-1627
Mailing address
136 GATEWAY BLVD STE A, MOORESVILLE, NC 28117-5608
(704) 799-2878
(704) 799-1627
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
118445
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89015J3
—
NC
Enumeration date
05/19/2006
Last updated
07/24/2013
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