Provider Demographics
NPI:1891780763
Name:PETERSON, NOEL (MD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2090 W ARLINGTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5727
Mailing Address - Country:US
Mailing Address - Phone:252-757-3333
Mailing Address - Fax:252-752-1786
Practice Address - Street 1:2090 W ARLINGTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5727
Practice Address - Country:US
Practice Address - Phone:252-757-3333
Practice Address - Fax:252-752-1786
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00812207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI3929OtherBCBS NC
NC5901348Medicaid
NC5901348Medicaid
NC136951Medicare UPIN