Provider Demographics
NPI:1558345892
Name:ESENSOY, TANER (MD)
Entity Type:Individual
Prefix:
First Name:TANER
Middle Name:
Last Name:ESENSOY
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 87407
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7407
Mailing Address - Country:US
Mailing Address - Phone:910-486-5437
Mailing Address - Fax:910-486-0011
Practice Address - Street 1:1327 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5531
Practice Address - Country:US
Practice Address - Phone:910-486-5437
Practice Address - Fax:910-486-0011
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891001VMedicaid
NC891001VMedicaid