Healthcare Provider Details

I. General information

NPI: 1962477877
Provider Name (Legal Business Name): DOUGLAS J TESTORI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 PHYSICIANS DR
WILMINGTON NC
28401-7356
US

IV. Provider business mailing address

PO BOX 602484
CHARLOTTE NC
28260-2484
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-5182
  • Fax: 910-763-0291
Mailing address:
  • Phone: 910-763-0291
  • Fax: 910-763-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2005-00851
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: