Wellington Provider Group PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WELLINGTON PROVIDER GROUP PC

Practice address

421 Fayetteville St Ste 1100
Raleigh, NC 27601-3000

Phone

(859) 518-8817

Fax

(859) 201-1084

NPI assigned

Dec 20, 2022

Organization subpart

Yes

Parent organization

WELLINGTON PROVIDER GROUP PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mariela Bravo

Title

Credentialing Team Lead

Phone

(859) 518-8817

Specialties & licenses 1

Addresses

Part of

Wellington Provider Group P

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1922710045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 WELLINGTON WAY STE 330",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031331",
            "telephone_number": "859-518-8817",
            "fax_number": "859-201-1084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 FAYETTEVILLE ST STE 1100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276013000",
            "telephone_number": "859-518-8817",
            "fax_number": "859-201-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLINGTON PROVIDER GROUP PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLINGTON PROVIDER GROUP PC",
        "enumeration_date": "2022-12-20",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "BRAVO",
        "authorized_official_first_name": "MARIELA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "859-518-8817"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.