Provider Demographics
NPI:1245228261
Name:NASCIMENTO, LUIZ (MD)
Entity type:Individual
Prefix:DR
First Name:LUIZ
Middle Name:
Last Name:NASCIMENTO
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 1:222 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-3322
Mailing Address - Country:US
Mailing Address - Phone:910-205-4000
Mailing Address - Fax:910-205-0090
Practice Address - Street 1:222 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-3322
Practice Address - Country:US
Practice Address - Phone:910-205-0400
Practice Address - Fax:910-205-0900
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32811207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014R7OtherCAROLINA ACCESS
SCN32811Medicaid
NCP00266132OtherRR MCR
NC61852OtherBCBS NC INDIV
NC7961852Medicaid
NC61852OtherBCBS NC INDIV
NC89014R7OtherCAROLINA ACCESS