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General NPI Number Information
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NPI Number | 1457794927
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Entity Type | Individual
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Provider Name | AMANDA JO LOTT MARCELLINO M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 3509 OLD BATTLEGROUND RD
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City | GREENSBORO
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State | NC
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Zip | 27410-2419
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Country | US
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Telephone | 336-438-2148
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Fax | 336-698-3832
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Provider Business Mailing Address
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Address Line | 3509 OLD BATTLEGROUND RD
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City | GREENSBORO
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State | NC
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Zip | 27410-2419
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Country | US
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Telephone | 336-438-2148
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Fax | 336-698-3832
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 201600327
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2016-00327
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License Number State | NC
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