MEDICARE: PROGRESS MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2012-01439	OTHER	NC	DOH

General Provider Information

NPI Number	:	1104431725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	2104 TALMAGE DR
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-9340
Country	:	US
Telephone Number	:	910-274-6718
Fax Number	:	910-782-0829

Provider Business Practice Location Address
First Line	:	1642 MILITARY CUTOFF RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5716
Country	:	US
Telephone Number	:	910-274-6718
Fax Number	:	910-782-0829

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA DOBSTAFF
Credential	:	MD
Telephone Number	:	910-274-6718

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	10/14/2024

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