Provider Demographics
NPI:1376537712
Name:MASTRANGELO, MICHAEL ROCCO (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROCCO
Last Name:MASTRANGELO
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-8300
Mailing Address - Fax:910-662-8361
Practice Address - Street 1:1520 PHYSICIANS DR
Practice Address - Street 2:STE B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7356
Practice Address - Country:US
Practice Address - Phone:910-662-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29144207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110065487OtherRAILROAD MEDICARE
NC1376537712Medicaid
NC8954668Medicaid
NCC85349Medicare UPIN
NC1376537712Medicaid
NC8954668Medicaid