Provider Demographics
NPI:1639155971
Name:DEMBOSKY, DELL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DELL
Middle Name:ANDREW
Last Name:DEMBOSKY
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 4270
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28370-8449
Mailing Address - Country:US
Mailing Address - Phone:910-687-4188
Mailing Address - Fax:843-479-6609
Practice Address - Street 1:30 PAGE ST.
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8449
Practice Address - Country:US
Practice Address - Phone:910-687-4188
Practice Address - Fax:843-479-6609
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14834207ZP0101X, 207ZP0102X
NC38927207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0789Medicaid
SCDF3784OtherRR MEDICARE
NC0120XOtherBCBS
SCGP3595Medicaid
SCGP2142Medicaid
NC890120XMedicaid
SC4469Medicare PIN
NC890120XMedicaid
SCGP0789Medicaid
SC5984Medicare PIN
SCGP2142Medicaid