MEDICARE: PAUL A. BUONGIORNO, M.D., P.A.

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	2084P0800X	Psychiatry Physician	95-01189	NC

General Provider Information

NPI Number	:	1366757254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL A. BUONGIORNO, M.D., P.A.

Provider Business Mailing Address
First Line	:	1402 S 17TH ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-6436
Country	:	US
Telephone Number	:	910-762-8400
Fax Number	:	910-762-9558

Provider Business Practice Location Address
First Line	:	1402 S 17TH ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-6436
Country	:	US
Telephone Number	:	910-762-8400
Fax Number	:	910-762-9558

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL BUONGIORNO
Credential	:	M.D.
Telephone Number	:	910-762-8400

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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