Healthcare Provider Details

I. General information

NPI: 1164983680
Provider Name (Legal Business Name): PALLAVI MISHRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4649
  • Fax: 336-713-2462
Mailing address:
  • Phone: 336-716-4649
  • Fax: 336-713-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number49308
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2023-02720
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: