Basic Information
| Provider Information | |||||||||
| NPI: | 1700879699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALLETTE | ||||||||
| FirstName: | JULIUS | ||||||||
| MiddleName: | Q | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W MARTIN LUTHER KING JR DR | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278894906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529400602 | ||||||||
| FaxNumber: | 2529400924 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 S QUEEN ST | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285014933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525229800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | 28261 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207VM0101X | 28261 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VX0000X | 28261 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 160034966 | 01 | NC | RAILROAD MEDICARE | OTHER | 53777 | 01 | NC | BCBS NC | OTHER | 8953777 | 05 | NC | MEDICAID | 2170961 | 01 | NC | MEDICARE | OTHER |