Provider Demographics
NPI:1811914435
Name:AZZATO, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:AZZATO
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:PO BOX 11515
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-1515
Mailing Address - Country:US
Mailing Address - Phone:910-454-8030
Mailing Address - Fax:
Practice Address - Street 1:1513 N HOWE ST STE 4
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2770
Practice Address - Country:US
Practice Address - Phone:910-805-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20698202C00000X, 208D00000X, 2251X0800X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912440Medicaid
NC8912440Medicaid
C81520Medicare UPIN