Provider Demographics
NPI:1497795553
Name:MEZZULLO, JOHN JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:MEZZULLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7305
Mailing Address - Country:US
Mailing Address - Phone:252-637-7300
Mailing Address - Fax:252-637-1772
Practice Address - Street 1:2800 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:TRENT WOODS
Practice Address - State:NC
Practice Address - Zip Code:28562-7305
Practice Address - Country:US
Practice Address - Phone:252-637-7300
Practice Address - Fax:252-637-1772
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99006112084P0800X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912325Medicaid
NC12325OtherBCBS OF NC
NCH05266Medicare UPIN
NC2401114BMedicare PIN
NC020045836Medicare PIN