| Wellington Provider Group PC | |
|
421 Fayetteville St Ste 1100 Raleigh NC 27601-3000 | |
| (859) 518-8817 | |
| (859) 201-1084 |
| Full Name | Wellington Provider Group PC |
|---|---|
| Speciality | Family Medicine |
| Location | 421 Fayetteville St Ste 1100, Raleigh, North Carolina |
| Authorized Official Name and Position | Mariela Bravo (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 8595188817 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellington Provider Group PC 535 Wellington Way Ste 330 Lexington KY 40503-1331 Ph: (859) 518-8817 | Wellington Provider Group PC 421 Fayetteville St Ste 1100 Raleigh NC 27601-3000 Ph: (859) 518-8817 |
| NPI Number | 1922710045 |
|---|---|
| Provider Enumeration Date | 12/20/2022 |
| Last Update Date | 12/20/2022 |
| Certification Date | 12/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922710045 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
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