Healthcare Provider Details

I. General information

NPI: 1699880971
Provider Name (Legal Business Name): PUNGO FAMILY MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 ALLEN STREET
BELHAVEN NC
27810-1405
US

IV. Provider business mailing address

245 ALLEN STREET
BELHAVEN NC
27810-1405
US

V. Phone/Fax

Practice location:
  • Phone: 252-944-2218
  • Fax: 252-943-2377
Mailing address:
  • Phone: 252-944-2218
  • Fax: 252-943-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. VANESSA D. BEAMER
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 252-944-2218