Healthcare Provider Details

I. General information

NPI: 1154525822
Provider Name (Legal Business Name): DOROTHY DEGUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

IV. Provider business mailing address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

V. Phone/Fax

Practice location:
  • Phone: 828-675-4119
  • Fax: 828-675-9312
Mailing address:
  • Phone: 828-675-4116
  • Fax: 828-675-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201100636
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200000984
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: