Provider Demographics
NPI:1679569693
Name:PIERSON, NOAH ROSS (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:ROSS
Last Name:PIERSON
Suffix:
Gender:M
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-6000
Mailing Address - Fax:910-662-9703
Practice Address - Street 1:510 CAROLINA BAY DR STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2046
Practice Address - Country:US
Practice Address - Phone:910-662-6000
Practice Address - Fax:910-662-9703
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8967744Medicaid
NC1679569693Medicaid
NC1679569693Medicaid
NC1022110001Medicare NSC
NC2204693PMedicare PIN
NC2204693KMedicare PIN
NC2204693MMedicare PIN
NCF92390Medicare UPIN
NC8967744Medicaid