Provider Demographics
NPI:1700063062
Name:VICENTE, DONETTE WELTANSIEHT (MD)
Entity Type:Individual
Prefix:
First Name:DONETTE
Middle Name:WELTANSIEHT
Last Name:VICENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONETTE
Other - Middle Name:WELTANSIEHT
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2901 BLUE RIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6423
Mailing Address - Country:US
Mailing Address - Phone:919-784-6818
Mailing Address - Fax:
Practice Address - Street 1:2901 BLUE RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6423
Practice Address - Country:US
Practice Address - Phone:919-784-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234963207R00000X
TN49486207RH0003X
NC2016-00099207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I839379OtherMEDICARE PTAN