Provider Demographics
NPI:1215301569
Name:PROSPECT BEHAVIORAL PEDIATRICS AND PSYCHIATRY
Entity type:Organization
Organization Name:PROSPECT BEHAVIORAL PEDIATRICS AND PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-440-8782
Mailing Address - Street 1:600 JULIAN LN STE 640
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7812
Mailing Address - Country:US
Mailing Address - Phone:828-552-3504
Mailing Address - Fax:828-552-3505
Practice Address - Street 1:600 JULIAN LN STE 640
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7812
Practice Address - Country:US
Practice Address - Phone:828-552-3504
Practice Address - Fax:828-552-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2140162084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty