Provider Demographics
NPI:1609869437
Name:PEREDA, LOURDES AMPARO (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:AMPARO
Last Name:PEREDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:PEREDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:285 W DORA ST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-9542
Mailing Address - Country:US
Mailing Address - Phone:919-639-9995
Mailing Address - Fax:919-639-3518
Practice Address - Street 1:285 W DORA ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-9542
Practice Address - Country:US
Practice Address - Phone:919-639-9995
Practice Address - Fax:919-639-3518
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004003972080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913682Medicaid
NC891368ZMedicaid
NC34D1088464OtherCLIA - CMS
NC13682OtherBLUE CROSS
BP8436304OtherDEA