Provider Demographics
NPI:1134320658
Name:MARCINKOWSKI, EMILY FONTENOT (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FONTENOT
Last Name:MARCINKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1414 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7505
Mailing Address - Country:US
Mailing Address - Phone:910-763-7363
Mailing Address - Fax:910-251-8296
Practice Address - Street 1:1414 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7505
Practice Address - Country:US
Practice Address - Phone:910-763-7363
Practice Address - Fax:910-251-8296
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY488642086X0206X
CA1308802086X0206X
NC201001333208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2010-01333OtherNORTH CAROLINA MEDICAL LICENSE
KY48864OtherKENTUCKY MEDICAL LICENSE