Provider Demographics
NPI:1528007226
Name:MUSSELWHITE, NEILL H III (MD)
Entity Type:Individual
Prefix:
First Name:NEILL
Middle Name:H
Last Name:MUSSELWHITE
Suffix:III
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 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-792-1144
Mailing Address - Fax:910-792-0160
Practice Address - Street 1:5145 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2207
Practice Address - Country:US
Practice Address - Phone:910-792-1144
Practice Address - Fax:910-792-0160
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1528007226Medicaid
NC8961634Medicaid
NC201605AMedicare PIN
NC1528007226Medicaid
NC080084957Medicare UPIN
NC201605BMedicare PIN
C85249Medicare UPIN
NC1022110001Medicare NSC