Provider Demographics
NPI:1649890864
Name:CRESENZO, JOHN VICTOR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VICTOR
Last Name:CRESENZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 SUSSEX ST APT D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4964
Mailing Address - Country:US
Mailing Address - Phone:336-552-5180
Mailing Address - Fax:
Practice Address - Street 1:930 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-890-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00799207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine