Healthcare Provider Details

I. General information

NPI: 1003851395
Provider Name (Legal Business Name): DAVID DEFEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 LYNDHURST AVE
WINSTON SALEM NC
27103-4007
US

IV. Provider business mailing address

3001 LYNDHURST AVE
WINSTON SALEM NC
27103-4007
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-0383
  • Fax: 336-768-1737
Mailing address:
  • Phone: 336-765-0383
  • Fax: 336-768-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number200401199
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number200401199
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number200401199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: