Provider Demographics
NPI:1417907619
Name:OVERTON III, DOLPHIN H III (MD)
Entity Type:Individual
Prefix:
First Name:DOLPHIN
Middle Name:H
Last Name:OVERTON III
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:388 VENTURE DR
Mailing Address - Street 2:STE I
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4775
Mailing Address - Country:US
Mailing Address - Phone:919-938-0811
Mailing Address - Fax:919-938-0816
Practice Address - Street 1:2806B WOOTEN BLVD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8624
Practice Address - Country:US
Practice Address - Phone:252-360-4374
Practice Address - Fax:252-360-4391
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39313207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC47292OtherMEDCOST
NC8964393Medicaid
NC7177348OtherAETNA
NC2331698OtherGROUP ORGANIZATION PTAN
NC64393OtherBLUE CROSS BLUE SHIELD
NC1521310OtherCIGNA
NC64393OtherBLUE CROSS BLUE SHIELD
NCNC5551AMedicare PIN