Basic Information
Provider Information | |||||||||
NPI: | 1548246507 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PIERSON | ||||||||
FirstName: | WILLARD | ||||||||
MiddleName: | CRESSE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2417 ATRIUM DR | ||||||||
Address2: | SUITE 150 | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276076673 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197912040 | ||||||||
FaxNumber: | 9197912041 | ||||||||
Practice Location | |||||||||
Address1: | 2417 ATRIUM DR | ||||||||
Address2: | SUITE 150 | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276076673 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197912040 | ||||||||
FaxNumber: | 9197912041 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/21/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 00-15154 | NC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 67747 | 01 | NC | BCBS | OTHER | 2950407 | 01 | NC | UNITED | OTHER | 4573955 | 01 | NC | CIGNA | OTHER | 30627 | 01 | NC | PARTNERS | OTHER | 8967747 | 05 | NC |   | MEDICAID | 95081 | 01 | NY | MEDCOST | OTHER | 289329 | 01 | NC | MAMSI | OTHER | 4221583 | 01 | NC | AETNA | OTHER |