Healthcare Provider Details

I. General information

NPI: 1396759262
Provider Name (Legal Business Name): NATHANIEL P NONOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S 17TH ST
WILMINGTON NC
28401-6444
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 910-442-1100
  • Fax: 910-442-1199
Mailing address:
  • Phone: 919-873-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200501129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: