Provider Demographics
NPI:1760491815
Name:PANCOTTO, FRANK S (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:S
Last Name:PANCOTTO
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 1:1070 VINEHAVEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-783-1840
Mailing Address - Fax:704-783-1850
Practice Address - Street 1:1070 VINEHAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-783-1840
Practice Address - Fax:704-783-1850
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24281207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8965172Medicaid
NC65172OtherBLUE CROSS BLUE SHIELD
NCC85872Medicare UPIN
NC209379CMedicare PIN