Provider Demographics
NPI:1649257742
Name:JANOSKO, EDWARD ORESTES II (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ORESTES
Last Name:JANOSKO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-362-8765
Mailing Address - Fax:910-362-9123
Practice Address - Street 1:1606 PHYSICIANS DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7348
Practice Address - Country:US
Practice Address - Phone:910-362-8765
Practice Address - Fax:910-362-9123
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC23206208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649257742Medicaid
NC8945786Medicaid
45786OtherBLUE CROSS
8988832002OtherCIGNA
45786OtherBLUE CROSS
NC1649257742Medicaid
NC207557FMedicare PIN