MEDICARE: LORI DIANE PEELE MD

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	207R00000X	Internal Medicine Physician	2005-01169	NC
2	207Q00000X	Family Medicine Physician	2005-01169	NC

General Provider Information

NPI Number	:	1407834278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI DIANE PEELE MD

Provider Business Mailing Address
First Line	:	10224 DURANT RD STE 209
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6468
Country	:	US
Telephone Number	:	919-322-8255
Fax Number	:	833-972-5896

Provider Business Practice Location Address
First Line	:	10224 DURANT RD STE 209
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6468
Country	:	US
Telephone Number	:	919-322-8255
Fax Number	:	919-646-9674

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/11/2024

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