Provider Demographics
NPI:1588905566
Name:PINEDA MALDONADO, ANDRES MAURICIO (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:MAURICIO
Last Name:PINEDA MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-642-8164
Mailing Address - Fax:910-642-8132
Practice Address - Street 1:800 JEFFERSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3710
Practice Address - Country:US
Practice Address - Phone:910-642-8164
Practice Address - Fax:910-642-8132
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2016-00720207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588905566Medicaid
NC1588905566Medicaid