Organization
VILLAGE PEDIATRICS OF CHAPEL HILL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM A GUSH M.D./P.H.D (PRESIDENT)
(919) 969-9611
Entity
Organization
Contact information
Practice address
300 MARKET ST STE 112, CHAPEL HILL, NC 27516-4493
(919) 969-9611
(919) 969-9615
Mailing address
300 MARKET ST STE 112, CHAPEL HILL, NC 27516-4493
(919) 969-9611
(919) 969-9615
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200500670
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017VK
BCBSNC GROUP NUMBER
NC
05
—
5903100
—
NC
Enumeration date
10/09/2006
Last updated
06/03/2015
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