Provider Demographics
NPI:1225059934
Name:SZURGOT, JENNIFER G (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:SZURGOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-255-4391
Practice Address - Street 1:15 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-255-4391
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909765Medicaid
149M6OtherBC/BS NC PROVIDER #
1225059934OtherMEDCOST PROVIDER #
SCN0040LOtherSC MEDICAID PROVIDER#
NC5909765Medicaid
2022355Medicare PIN