Provider Demographics
NPI:1710470695
Name:MAGGIONCALDA, ELISE ANN (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:ANN
Last Name:MAGGIONCALDA
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 1:2000 OLD CLINIC CB# 7510
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7510
Mailing Address - Country:US
Mailing Address - Phone:984-974-1884
Mailing Address - Fax:803-434-4160
Practice Address - Street 1:2000 OLD CLINIC CB# 7510
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:984-974-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL52684207R00000X
NCRTL19-02092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine