Provider Demographics
NPI:1043250996
Name:MCMENEMY, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MCMENEMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 VILCOM CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1789
Mailing Address - Country:US
Mailing Address - Phone:919-521-8159
Mailing Address - Fax:330-343-7805
Practice Address - Street 1:77 VILCOM CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1789
Practice Address - Country:US
Practice Address - Phone:919-521-8159
Practice Address - Fax:919-933-3816
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC96-00638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955790Medicaid
NC55790OtherBCBS
NC8955790Medicaid
NCG28265Medicare UPIN