Provider Demographics
NPI:1154333284
Name:ZERVOS, EMMANUEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:E
Last Name:ZERVOS
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 751069
Mailing Address - Street 2:LEO JENKINS CANCER SERVICES
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:LEO JENKINS CANCER SERVICES
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-1888
Practice Address - Fax:252-744-7005
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84596208600000X
NC2007013582086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262133900Medicaid
NC1455WOtherBCBSNC
NC5907611Medicaid
FL02524OtherBLUE CROSS BLUE SHIELD
NC2073437AMedicare PIN
NC1455WOtherBCBSNC
FL02524ZMedicare PIN
FL020052221Medicare PIN
FLH43714Medicare UPIN