Provider Demographics
NPI:1598727794
Name:DENUNZIO, NEIL LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:LOUIS
Last Name:DENUNZIO
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 9
Mailing Address - Street 2:
Mailing Address - City:WINFALL
Mailing Address - State:NC
Mailing Address - Zip Code:27985-0009
Mailing Address - Country:US
Mailing Address - Phone:252-426-9172
Mailing Address - Fax:252-426-8185
Practice Address - Street 1:333 WINFALL BLVD
Practice Address - Street 2:
Practice Address - City:WINFALL
Practice Address - State:NC
Practice Address - Zip Code:27985
Practice Address - Country:US
Practice Address - Phone:252-426-9172
Practice Address - Fax:252-426-8185
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0029103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928349Medicaid
E01417Medicare UPIN
NC8928349Medicaid