Provider Demographics
NPI:1124407150
Name:PUZZO, CARLO J (DO)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:J
Last Name:PUZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1408
Mailing Address - Street 2:300 WEST 27TH ST.
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359
Mailing Address - Country:US
Mailing Address - Phone:910-738-2662
Mailing Address - Fax:910-272-7153
Practice Address - Street 1:300 WEST 27TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-738-2662
Practice Address - Fax:910-272-7153
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2016-12-27
Deactivation Date:2016-01-13
Deactivation Code:
Reactivation Date:2016-02-08
Provider Licenses
StateLicense IDTaxonomies
NC209341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine