Active NPI
Pieter Cameron Vaniderstine, M.A.
- Intellectual & Developmental Disabilities Psychologist
- Greensboro, NC
National Provider Identifier
1043460165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- License
- 1004
- Practice address
- 122 N Elm St
Suite 400
Greensboro, NC 27401-2878 - Phone
- (336) 334-5601
- Fax
- (336) 334-5657
- NPI assigned
- Sep 25, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1004 | NC | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 1004 | NC | Primary |
Addresses
Primary practice location
122 N Elm St
Suite 400
Greensboro, NC 27401-2878
Mailing address
122 N Elm St
Suite 400
Greensboro, NC 27401-2878
Phone (336) 334-5601
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3403407 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1004 | NC | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NC DHHS Child and Family Well-Being | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Early Intervention Provider Agency
- Greensboro, NC
- NPI 1568686988
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222300800000",
"number": "1043460165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 N ELM ST",
"address_2": "SUITE 400",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274012878",
"telephone_number": "336-334-5601",
"fax_number": "336-334-5657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 N ELM ST",
"address_2": "SUITE 400",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274012878",
"telephone_number": "336-334-5601",
"fax_number": "336-334-5657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANIDERSTINE",
"first_name": "PIETER",
"middle_name": "CAMERON",
"name_prefix": "Mr.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-25",
"last_updated": "2008-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "1004",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "NC",
"license": "1004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3403407",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.