Provider Demographics
NPI:1982820999
Name:PINETREE CLINIC, PLLC
Entity Type:Organization
Organization Name:PINETREE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WLODARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-295-2900
Mailing Address - Street 1:289 OLMSTED BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9023
Mailing Address - Country:US
Mailing Address - Phone:910-295-2900
Mailing Address - Fax:910-295-2935
Practice Address - Street 1:289 OLMSTED BLVD STE 7
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9023
Practice Address - Country:US
Practice Address - Phone:910-295-2900
Practice Address - Fax:910-295-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501458261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care