Provider Demographics
NPI:1598081986
Name:GIOVACCHINI, CORAL XANTIA (MD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:XANTIA
Last Name:GIOVACCHINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:XANTIA
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DUMC BOX 3182, DEPT OF MEDICINE
Mailing Address - Street 2:MEDICAL RESIDENCY EDUCATION OFFICE
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1666
Mailing Address - Country:US
Mailing Address - Phone:919-681-2382
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC165091(RTL)390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program