Provider Demographics
NPI:1205965068
Name:DEBNAM, MARIE GEORGETTE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:GEORGETTE
Last Name:DEBNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:524 S BLOUNT ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1828
Mailing Address - Country:US
Mailing Address - Phone:919-832-1667
Mailing Address - Fax:919-832-0393
Practice Address - Street 1:524 S BLOUNT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1828
Practice Address - Country:US
Practice Address - Phone:919-832-1667
Practice Address - Fax:919-832-0393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928064Medicaid
NC2223164Medicare PIN
NC8928064Medicaid