Provider Demographics
NPI:1700984812
Name:D'AVANZO, NICHOLAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:D'AVANZO
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 1:8512 BELL GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3183
Mailing Address - Country:US
Mailing Address - Phone:919-844-3225
Mailing Address - Fax:
Practice Address - Street 1:3124 BLUE RIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8041
Practice Address - Country:US
Practice Address - Phone:919-782-0021
Practice Address - Fax:919-571-0825
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC49871OtherMEDCOST
NC6298565OtherCIGNA
NC117079OtherWELLPATH
NC1252687OtherUNITED HEALTHCARE
NC27876OtherBCBS OF NC
NC5204341OtherAETNA
NC8927876Medicaid
NC5204341OtherAETNA