MEDICARE: DR. LOURDES AMPARO PEREDA 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	2080N0001X	Neonatal-Perinatal Medicine Physician	200400397	NC
2	208000000X	Pediatrics Physician	200400397	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	34D1088464	OTHER	NC	CLIA - CMS
4	13682	OTHER	NC	BLUE CROSS

General Provider Information

NPI Number	:	1609869437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOURDES AMPARO PEREDA MD

Provider Business Mailing Address
First Line	:	285 W DORA ST
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-9542
Country	:	US
Telephone Number	:	919-639-9995
Fax Number	:	919-639-3518

Provider Business Practice Location Address
First Line	:	285 W DORA ST
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-9542
Country	:	US
Telephone Number	:	919-639-9995
Fax Number	:	919-639-3518

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	03/07/2023

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