Provider Demographics
NPI:1568564482
Name:MOREHOUSE, WINIFRED V (MD)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:V
Last Name:MOREHOUSE
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 1:600 JULIAN LN
Mailing Address - Street 2:SUITE 630
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7813
Mailing Address - Country:US
Mailing Address - Phone:828-651-0121
Mailing Address - Fax:828-651-0141
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:SUITE 630
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7813
Practice Address - Country:US
Practice Address - Phone:828-651-0121
Practice Address - Fax:828-651-0141
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01675207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA917969962AMedicaid
SCG55422Medicaid
GAP00214795Medicare PIN
SCG55422Medicaid
GA11SCDGJMedicare PIN