Provider Demographics
NPI:1639171366
Name:ZELLNER, ERIC G B (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:G B
Last Name:ZELLNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2930 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3815
Mailing Address - Country:US
Mailing Address - Phone:910-323-9010
Mailing Address - Fax:910-829-9530
Practice Address - Street 1:2930 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3815
Practice Address - Country:US
Practice Address - Phone:910-323-9010
Practice Address - Fax:910-829-9530
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29192208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC009082OtherDOCTORS HEALTH PLAN
NC5127109OtherAETNA
NC8989873Medicaid
NC20180OtherDOCTORS HEALTH PLAN
NC2338888OtherUNITED HEALTH CARE
NC2338887OtherPHYSICIANS HEALTH PLAN
NC8989932Medicaid
NC932585OtherMAILHANDLERS
NC561750169001OtherTRICARE
NC561750169002OtherCIGNA HEALTH CARE
NC89932OtherBCBS NC
NCA2457OtherMEDCOST
NC2338888OtherUNITED HEALTH CARE
NC009082OtherDOCTORS HEALTH PLAN
NC8989873Medicaid