Healthcare Provider Details

I. General information

NPI: 1609869437
Provider Name (Legal Business Name): LOURDES AMPARO PEREDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOURDES PEREDA M.D

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W DORA ST
ANGIER NC
27501-9542
US

IV. Provider business mailing address

285 W DORA ST
ANGIER NC
27501-9542
US

V. Phone/Fax

Practice location:
  • Phone: 919-639-9995
  • Fax: 919-639-3518
Mailing address:
  • Phone: 919-639-9995
  • Fax: 919-639-3518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200400397
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number200400397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: