Healthcare Provider Details

I. General information

NPI: 1407858699
Provider Name (Legal Business Name): MARILYNN A PRINCE-FIOCCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 MEDICAL CENTER DR
WILMINGTON NC
28401-7353
US

IV. Provider business mailing address

1090 MEDICAL CENTER DR
WILMINGTON NC
28401-7353
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-3345
  • Fax: 910-343-1924
Mailing address:
  • Phone: 910-343-3345
  • Fax: 910-343-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2013-02084
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2013-02084
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2013-02084
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: