Provider Demographics
NPI:1770684292
Name:VREELAND, GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:VREELAND
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 1:1333 S DICKINSON DR
Mailing Address - Street 2:#140
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6430
Mailing Address - Country:US
Mailing Address - Phone:910-371-0404
Mailing Address - Fax:910-371-1005
Practice Address - Street 1:1333 S DICKINSON DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6430
Practice Address - Country:US
Practice Address - Phone:910-371-0404
Practice Address - Fax:910-371-1005
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0401000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00184032OtherRAILROAD MEDICARE
NC137HJOtherBCBS NC
NC89137HJMedicaid
NCA49168Medicare UPIN
NCP00184032OtherRAILROAD MEDICARE
NC137HJOtherBCBS NC
NC2030876Medicare PIN