Provider Demographics
NPI:1912078437
Name:FIORILLI, MARIO GRAZIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:GRAZIA
Last Name:FIORILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:270 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-537-0134
Practice Address - Fax:252-537-6515
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20391207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5831059OtherVIRGINIA MEDICAID
1435956HALIOtherUNITED MINE WORKERS
04 55331OtherUNITED HEALTHCARE
NC32080OtherBCBSNC
020384900OtherDIVISION OF COAL MINERS
NC028182OtherVABCBS
01623972OtherMEDCOST
110093481OtherRR MEDICARE PALMETTO
18619OtherCAPITOL BC PENN
NC8932080Medicaid
NC32080OtherBCBSNC
NC8932080Medicaid
NCNCL026E526Medicare PIN