Provider Demographics
NPI:1679550834
Name:PINARD, JACQUELINE BEDINGFIELD
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BEDINGFIELD
Last Name:PINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:VEDE
Other - Last Name:BEDINGFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602478
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2478
Mailing Address - Country:US
Mailing Address - Phone:704-867-5356
Mailing Address - Fax:704-867-4990
Practice Address - Street 1:2544 COURT DR
Practice Address - Street 2:SUITE C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-867-5356
Practice Address - Fax:704-867-4990
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2710Medicaid
NC1679550834Medicaid
NC891057AMedicaid