Provider Demographics
NPI:1629076690
Name:MARIA, JOSETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSETTE
Middle Name:
Last Name:MARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SUSAN TART RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5506
Mailing Address - Country:US
Mailing Address - Phone:910-892-8892
Mailing Address - Fax:910-892-1063
Practice Address - Street 1:800 SUSAN TART RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5506
Practice Address - Country:US
Practice Address - Phone:910-892-8892
Practice Address - Fax:910-892-1063
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100412207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891281EMedicaid
NC1281EOtherBCBS NC PROVIDER NUMBER
NC1281EOtherBCBS NC PROVIDER NUMBER
NCH04645Medicare UPIN