Provider Demographics
NPI:1083696603
Name:ONGJOCO, RODOLFO DE LOSSANTOS JR (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:DE LOSSANTOS
Last Name:ONGJOCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODOLFO
Other - Middle Name:S
Other - Last Name:ONGJOCO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:180 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7020
Mailing Address - Country:US
Mailing Address - Phone:910-246-0567
Mailing Address - Fax:910-246-0669
Practice Address - Street 1:180 PERRY DR
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7020
Practice Address - Country:US
Practice Address - Phone:910-246-0567
Practice Address - Fax:910-246-0669
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95001702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89764208Medicaid
NC89764208Medicaid
NC2210872EMedicare PIN