Provider Demographics
NPI:1770704934
Name:PELLETIER, JR., GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:PELLETIER, JR.
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 1:413 HAYWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-671-2605
Mailing Address - Fax:
Practice Address - Street 1:1315 TATUM DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-633-1599
Practice Address - Fax:252-634-9889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966722Medicaid
NC8966722Medicaid
NCC85941Medicare UPIN