MEDICARE: LUKE ALEXANDER PEARSALL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	103595	NC

General Provider Information

NPI Number	:	1134177306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE ALEXANDER PEARSALL PA

Provider Business Mailing Address
First Line	:	3001 LYNDHURST AVE
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-4007
Country	:	US
Telephone Number	:	336-765-0383
Fax Number	:	336-768-1737

Provider Business Practice Location Address
First Line	:	3001 LYNDHURST AVE
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-4007
Country	:	US
Telephone Number	:	336-765-0383
Fax Number	:	336-768-1737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/25/2021

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