Healthcare Provider Details

I. General information

NPI: 1275602708
Provider Name (Legal Business Name): EKATERINA VAPNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4529 JESSUP GROVE RD
GREENSBORO NC
27410-9407
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-605-0190
  • Fax: 336-605-0930
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200400089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: