Provider Demographics
NPI:1871588145
Name:FEMI-PEARSE, JUNI A (MD)
Entity type:Individual
Prefix:
First Name:JUNI
Middle Name:A
Last Name:FEMI-PEARSE
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 1:5484 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3792
Mailing Address - Country:US
Mailing Address - Phone:505-702-5404
Mailing Address - Fax:757-228-7323
Practice Address - Street 1:5484 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3782
Practice Address - Country:US
Practice Address - Phone:505-702-5404
Practice Address - Fax:757-228-7323
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35066208600000X
VA0101221384208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007310358Medicaid
KY64001043Medicaid
KY64001043Medicaid
KY1802901Medicare PIN
VA007310358Medicaid