Provider Demographics
NPI:1982100509
Name:MAGALSKI, DILLON JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DILLON
Middle Name:JAMES
Last Name:MAGALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Mailing Address - Street 2:MEDICAL CENTER BOULEVARD
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-7795
Mailing Address - Fax:
Practice Address - Street 1:PEACE HAVEN FAMILY MEDICINE
Practice Address - Street 2:1930 N PEACE HAVEN RD
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4817
Practice Address - Country:US
Practice Address - Phone:336-713-7795
Practice Address - Fax:336-713-7801
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2021-00741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program