Provider Demographics
NPI:1063480598
Name:DESPAIGNE, POLICARPO RODNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:POLICARPO
Middle Name:RODNEY
Last Name:DESPAIGNE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 JACKEYS CREEK LN SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9204
Mailing Address - Country:US
Mailing Address - Phone:910-371-1980
Mailing Address - Fax:
Practice Address - Street 1:1135 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3966
Practice Address - Country:US
Practice Address - Phone:910-256-6222
Practice Address - Fax:910-256-0011
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752071PMedicare PIN
S83377Medicare UPIN
NC2752071GMedicare PIN
NC2752071NMedicare PIN