Healthcare Provider Details

I. General information

NPI: 1104576362
Provider Name (Legal Business Name): PEARL IGWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20036 ZION AVE STE 100
CORNELIUS NC
28031-8435
US

IV. Provider business mailing address

20036 ZION AVE STE 100
CORNELIUS NC
28031-8435
US

V. Phone/Fax

Practice location:
  • Phone: 704-801-7400
  • Fax:
Mailing address:
  • Phone: 704-801-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-03796
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2026-03796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: