Provider Demographics
NPI:1083751044
Name:BIZZELL, CARY FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:FREDERICK
Last Name:BIZZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-1757
Mailing Address - Country:US
Mailing Address - Phone:919-734-1866
Mailing Address - Fax:919-736-1804
Practice Address - Street 1:2700 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-734-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD652952085R0202X
NC2011-001082085R0202X
NC1706942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00974076OtherRAILROAD MEDICARE
MD032654200Medicaid
NC5917797Medicaid
MD180582YSJMedicare PIN
NCNC0273AMedicare PIN