Provider Demographics
NPI:1174551733
Name:EUGENIO, EMMANUEL ESTRANERO (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ESTRANERO
Last Name:EUGENIO
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 1:36 MCNEILL PLZ
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-8602
Mailing Address - Country:US
Mailing Address - Phone:910-640-4064
Mailing Address - Fax:
Practice Address - Street 1:36 MCNEILL PLZ
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8602
Practice Address - Country:US
Practice Address - Phone:910-640-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-01504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA270500OtherSOUTHERN HEALTH SERVICES
VA4944612OtherCIGNA
VA854726OtherMAMSI
NC1174551733Medicaid
VAC06193OtherGROUP PTAN
VA006710018Medicaid
VA223542OtherANTHEM BCBS OF VA
VA45912OtherSENTARA
VA5488498OtherAETNA HMO
VA5488498OtherAETNA LIFE