Provider Demographics
NPI:1558353847
Name:LANDUCCI, DANTE L (MD)
Entity Type:Individual
Prefix:DR
First Name:DANTE
Middle Name:L
Last Name:LANDUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:1800 W 5TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2888
Practice Address - Country:US
Practice Address - Phone:252-744-2207
Practice Address - Fax:252-744-1115
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9900579207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911938Medicaid
NC290012072OtherRAILROAD MEDICARE
NC11938OtherBCBS NC
NC8911938Medicaid
NCC36147Medicare UPIN