Healthcare Provider Details

I. General information

NPI: 1134320658
Provider Name (Legal Business Name): EMILY FONTENOT MARCINKOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 IRON GATE DR
WILMINGTON NC
28412-3731
US

IV. Provider business mailing address

2739 IRON GATE DR
WILMINGTON NC
28412-3731
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-7363
  • Fax: 910-251-8296
Mailing address:
  • Phone: 910-763-7363
  • Fax: 910-251-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number201001333
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number201001333
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: