Healthcare Provider Details

I. General information

NPI: 1124037692
Provider Name (Legal Business Name): DAVID CHARLES PETTIGREW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BILTMORE AVE
ASHEVILLE NC
28801
US

IV. Provider business mailing address

50 SCHENCK PKWY
ASHEVILLE NC
28803-3499
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1740
  • Fax: 828-213-1742
Mailing address:
  • Phone: 828-213-1740
  • Fax: 828-213-1742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number201501886
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201501886
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME91053
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2015-01886
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number70934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: