Provider Demographics
NPI:1720141377
Name:PEARSON, MARILYN R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:R
Last Name:PEARSON
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 1:517 N BRIGHTLEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-989-5200
Mailing Address - Fax:919-989-5208
Practice Address - Street 1:517 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-989-5200
Practice Address - Fax:919-989-5208
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911859Medicaid
NC9601431OtherLICENSE NUMBER
NCBP5230470OtherDEA NUMBER
NCG75139Medicare UPIN
NC2253745Medicare ID - Type UnspecifiedMEDICARE NUMBER