Healthcare Provider Details

I. General information

NPI: 1801945571
Provider Name (Legal Business Name): WILMINGTON ENDOCRINOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SHIPYARD BLVD SUITE 220
WILMINGTON NC
28403-8023
US

IV. Provider business mailing address

PO BOX 3788
WILMINGTON NC
28406-0788
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-9464
  • Fax: 910-254-3474
Mailing address:
  • Phone: 910-254-9464
  • Fax: 910-254-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number110902
License Number StateNC

VIII. Authorized Official

Name: DR. GHOBAD AZIZI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 910-254-9464