Healthcare Provider Details

I. General information

NPI: 1306143219
Provider Name (Legal Business Name): ALEXIS PIERINO GOSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEART DRIVE MAILSTOP 654 ECU PHYSICIANS FAMILY MEDICINE
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-4611
  • Fax: 252-744-2056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001002753
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: