Healthcare Provider Details

I. General information

NPI: 1891757498
Provider Name (Legal Business Name): MIGUEL A PINEIRO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S MADISON BLVD
ROXBORO NC
27573-5428
US

IV. Provider business mailing address

PO BOX 61474
DURHAM NC
27715-1474
US

V. Phone/Fax

Practice location:
  • Phone: 336-598-5480
  • Fax:
Mailing address:
  • Phone: 919-544-6318
  • Fax: 919-544-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number104137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: