Provider Demographics
NPI:1407858699
Name:PRINCE-FIOCCO, MARILYNN A (MD)
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:A
Last Name:PRINCE-FIOCCO
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 1:1090 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7353
Mailing Address - Country:US
Mailing Address - Phone:910-343-3345
Mailing Address - Fax:910-343-1924
Practice Address - Street 1:1090 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7353
Practice Address - Country:US
Practice Address - Phone:910-343-3345
Practice Address - Fax:910-343-1924
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02084207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1888497-01Medicaid
WI31987500Medicaid
TX8AH512OtherMEDICARE - TEXAS
D73358Medicare UPIN
WI31987500Medicaid