Healthcare Provider Details

I. General information

NPI: 1255412631
Provider Name (Legal Business Name): PAUL E IACONO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL DRIVE SUITE 5-D
HENDERSONVILLE NC
28792-5247
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-1030
  • Fax: 828-687-8229
Mailing address:
  • Phone: 828-687-6282
  • Fax: 828-687-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number9600576
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: