Provider Demographics
NPI:1285999458
Name:CALVARY PEDIATRICS
Entity type:Organization
Organization Name:CALVARY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:OSAZE
Authorized Official - Last Name:ASEMOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-484-4233
Mailing Address - Street 1:509 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4433
Mailing Address - Country:US
Mailing Address - Phone:910-484-4233
Mailing Address - Fax:910-484-2990
Practice Address - Street 1:509 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4433
Practice Address - Country:US
Practice Address - Phone:910-484-4233
Practice Address - Fax:910-484-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty