Healthcare Provider Details

I. General information

NPI: 1356753453
Provider Name (Legal Business Name): JOHN ANTHONY FETCHERO III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E DAVIE ST
RALEIGH NC
27601-1806
US

IV. Provider business mailing address

PO BOX 803854
KANSAS CITY MO
64180-3854
US

V. Phone/Fax

Practice location:
  • Phone: 919-834-5299
  • Fax:
Mailing address:
  • Phone: 919-350-0351
  • Fax: 919-350-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-01580
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20559
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: