Healthcare Provider Details

I. General information

NPI: 1568489441
Provider Name (Legal Business Name): JOSEPH R. PRINGLE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 S WILLIAMSON AVE
ELON NC
27244-9280
US

IV. Provider business mailing address

PO BOX 1717
BURLINGTON NC
27216-1717
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-1234
  • Fax: 336-538-2390
Mailing address:
  • Phone: 336-538-1234
  • Fax: 336-538-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21434
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8969234
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: