Provider Demographics
NPI:1427106186
Name:PINEHURST WOMENS CLINIC PA
Entity type:Organization
Organization Name:PINEHURST WOMENS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:PULEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-410-9494
Mailing Address - Street 1:110 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-5220
Mailing Address - Country:US
Mailing Address - Phone:910-410-9494
Mailing Address - Fax:910-410-9484
Practice Address - Street 1:70 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8707
Practice Address - Country:US
Practice Address - Phone:910-410-9494
Practice Address - Fax:910-410-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902114Medicaid
NC89014KGMedicaid
NC89014KGMedicaid
NC2331533Medicare PIN