Provider Demographics
NPI:1326242397
Name:PESANTE, MAISHA (MD)
Entity Type:Individual
Prefix:
First Name:MAISHA
Middle Name:
Last Name:PESANTE
Suffix:
Gender:F
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 2723
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2723
Mailing Address - Country:US
Mailing Address - Phone:252-212-3486
Mailing Address - Fax:252-212-3497
Practice Address - Street 1:111 S FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6971
Practice Address - Country:US
Practice Address - Phone:252-446-3333
Practice Address - Fax:252-446-0426
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013713207Q00000X
NY286857207Q00000X
MDD82892207Q00000X
DEC1-0011962207Q00000X
IN01077907A207Q00000X
MEMD21379207Q00000X
NJ25MA10028800207Q00000X
PAMD460049207Q00000X
CT55962207Q00000X
MI4301111261207Q00000X
RIMD15634207Q00000X
OH35.089492207Q00000X
ARE-12705207Q00000X
GA84764207Q00000X
NC2012-00930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine