Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Peter Daniel Bourland, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1710510565

Peter Daniel Bourland, PHYSICIANASSISTANT is a Physician Assistant in Raleigh, North Carolina. Qualified in 2019, 7 years ago. Practices with North Carolina Mg LLC, a 712-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in North Carolina.

Years since qualifying
7
Licensed in
NC
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

4420 Lake Boone Trl
Raleigh, NC 27607-7505
Phone: (919) 784-2576
Fax: (919) 784-2577
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 130 M St Ne Apt 1113, Washington, DC 20002-7925 — (336) 413-9578

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-14932 (NC)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1710510565
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedFebruary 20, 2020
Last updated in NPPESApril 10, 2025
Certification dateApril 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice North Carolina Mg Llc — 712 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Raleigh