Healthcare Provider Details

I. General information

NPI: 1275794703
Provider Name (Legal Business Name): CALEB EVANS PINEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM STREET SUITE 1100
RALEIGH NC
27617-8228
US

IV. Provider business mailing address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

V. Phone/Fax

Practice location:
  • Phone: 919-206-4889
  • Fax: 919-484-8218
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201100483
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: