Provider Demographics
NPI:1265437008
Name:KNAB, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:KNAB
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:PO BOX 3578
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0578
Mailing Address - Country:US
Mailing Address - Phone:910-442-1200
Mailing Address - Fax:910-442-1296
Practice Address - Street 1:1602 PHYSICIANS DR
Practice Address - Street 2:STE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7350
Practice Address - Country:US
Practice Address - Phone:910-442-1200
Practice Address - Fax:910-442-1296
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001395208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127NCMedicaid
NC89127NCMedicaid
NC1528063542Medicare PIN
2281225Medicare ID - Type Unspecified