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1801896618

NPI Code Detail

MEDICARE: GRACE MAYAMIKO JERE MD

MEDICARE: GRACE MAYAMIKO JERE 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	2008-00543	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00671247	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212661	OTHER	NC	MEDCOST
2	6280481	OTHER	NC	AETNA
3	150YG	OTHER	NC	BCBS OF NC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7348979	OTHER	NC	CIGNA
7	2587554	OTHER	NC	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1801896618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MAYAMIKO JERE MD

Provider Business Mailing Address
First Line	:	PO BOX 7200
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-0200
Country	:	US
Telephone Number	:	252-937-0200
Fax Number	:	252-451-0056

Provider Business Practice Location Address
First Line	:	91 ENTERPRISE DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-9590
Country	:	US
Telephone Number	:	252-937-0235
Fax Number	:	252-937-3103

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/07/2023

Similar Medicare Providers

1023645637 — DR. LUISA FERNANDA GONZALEZ MD
Practice Location Address:

91 ENTERPRISE DR
ROCKY MOUNT, NC
27804-9590

Practice Phone: 252-451-3100
Practice Fax: 252-937-3106

1588658504 — DONALD W BALES MD
Practice Location Address:

91 ENTERPRISE DR
ROCKY MOUNT, NC
27804-9590

Practice Phone: 252-937-0235
Practice Fax: 252-937-3103

1659365690 — MARTHA J CHESNUTT MD
Practice Location Address:

91 ENTERPRISE DR
ROCKY MOUNT, NC
27804-9590

Practice Phone: 252-451-3200
Practice Fax: 252-937-3107

1053305052 — DAVID S BRANTLEY MD
Practice Location Address:

91 ENTERPRISE DR
ROCKY MOUNT, NC
27804-9590

Practice Phone: 252-451-3100
Practice Fax: 252-937-3106

1205820214 — VASANTH B BALIGA MD
Practice Location Address:

91 ENTERPRISE DR
ROCKY MOUNT, NC
27804-9590

Practice Phone: 252-451-3100
Practice Fax: 252-937-3106

1194719104 — DAVID ALLEN BROWDER MD
Practice Location Address:

91 ENTERPRISE DR
ROCKY MOUNT, NC
27804-9590

Practice Phone: 252-451-3200
Practice Fax: 252-937-3107

Directions to “ GRACE MAYAMIKO JERE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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