Healthcare Provider Details

I. General information

NPI: 1508843921
Provider Name (Legal Business Name): PATRICIA A VINOCUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 S FAYETTEVILLE ST
ASHEBORO NC
27203-6667
US

IV. Provider business mailing address

PO BOX 5418
ASHEBORO NC
27204-5418
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-2467
  • Fax: 336-625-2256
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200001322
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: