Basic Information
| Provider Information | |||||||||
| NPI: | 1982066296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SITES | ||||||||
| FirstName: | JEREMY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661072 | ||||||||
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| Practice Location | |||||||||
| Address1: | KY CHILDREN'S HOSPITAL 800 ROSE ST 4TH FLOOR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405362110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592180921 | ||||||||
| FaxNumber: | 8592571831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2019-01088 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | TP940 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.