MEDICARE: LOUISE ANN PECEVICH P.A.

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	363A00000X	Physician Assistant	363A00000X	CA
2	363AM0700X	Medical Physician Assistant	PA2582	MA
3	363A00000X	Physician Assistant	103743	NC

General Provider Information

NPI Number	:	1841236353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE ANN PECEVICH P.A.

Provider Business Mailing Address
First Line	:	159 RIVERCHASE RD
Second Line	:
City	:	PINNACLE
State	:	NC
Zip	:	27043-8515
Country	:	US
Telephone Number	:	843-209-6704
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	843-209-6704
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/02/2024

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Directions to “ LOUISE ANN PECEVICH P.A.” Practice Location

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