Provider Demographics
NPI:1831240308
Name:MEWBORN, QUENTIN ALEXANDER JR (MD)
Entity type:Individual
Prefix:DR
First Name:QUENTIN
Middle Name:ALEXANDER
Last Name:MEWBORN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 MOYE BLVD.
Mailing Address - Street 2:STE. A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-752-7133
Mailing Address - Fax:252-752-6120
Practice Address - Street 1:2210 HEMBY LN
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3773
Practice Address - Country:US
Practice Address - Phone:252-752-7133
Practice Address - Fax:252-752-6120
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2022-01-31
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Provider Licenses
StateLicense IDTaxonomies
NC16423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958755Medicaid
208833Medicare ID - Type Unspecified
NC8958755Medicaid