Healthcare Provider Details

I. General information

NPI: 1043070915
Provider Name (Legal Business Name): JONATHAN EDWARD REPPEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 MEDICAL CAMPUS DRIVE
GOLDSBORO NC
27531-4810
US

IV. Provider business mailing address

2803 MEDICAL CAMPUS DRIVE
GOLDSBORO NC
27531-4810
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-1802
  • Fax:
Mailing address:
  • Phone: 919-722-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-02980
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: