Provider Demographics
NPI:1740264084
Name:NGO, CORAZON (MD)
Entity type:Individual
Prefix:MRS
First Name:CORAZON
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORAZON
Other - Middle Name:
Other - Last Name:NGO SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:214 DUPLIN ST
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-9024
Mailing Address - Country:US
Mailing Address - Phone:910-296-1811
Mailing Address - Fax:910-296-0862
Practice Address - Street 1:214 DUPLIN ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-9024
Practice Address - Country:US
Practice Address - Phone:910-296-1811
Practice Address - Fax:910-296-0862
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8962477Medicaid
NC201488Medicare ID - Type Unspecified
C80706Medicare UPIN