Provider Demographics
NPI:1821075805
Name:BUONGIORNO, PAUL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:BUONGIORNO
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 1:1402 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6436
Mailing Address - Country:US
Mailing Address - Phone:910-762-8400
Mailing Address - Fax:910-762-9558
Practice Address - Street 1:1402 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6436
Practice Address - Country:US
Practice Address - Phone:910-762-8400
Practice Address - Fax:910-762-9558
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC011892084P0800X
VA343642084P0800X
DC130022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19910OtherBLUE CROSS BLUE SHIELD NC
C88991Medicare UPIN
NC2218580Medicare ID - Type Unspecified