MEDICARE: DR. NANCY L CENTOFANTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	198493	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68639503	OTHER	MD	BCBS MD
2	F2320002	OTHER	MD	BCBS DC NCA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992762777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY L CENTOFANTE MD

Provider Business Mailing Address
First Line	:	1706 MEDICAL PARK DR W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-2705
Country	:	US
Telephone Number	:	410-708-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 MEDICAL PARK DR W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-2705
Country	:	US
Telephone Number	:	252-243-3223
Fax Number	:	252-243-3668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	09/16/2020

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