Provider Demographics
NPI:1083935928
Name:WARREN, MILDRED PELLETIER (MD)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:PELLETIER
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7244
Mailing Address - Country:US
Mailing Address - Phone:252-752-4124
Mailing Address - Fax:252-758-8954
Practice Address - Street 1:1165 CEDAR POINT BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8023
Practice Address - Country:US
Practice Address - Phone:252-752-4124
Practice Address - Fax:252-758-8954
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01581207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083935928OtherNPI