MEDICARE: HUGO A TETTAMANTI MD PA

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	207RN0300X	Nephrology Physician	18235	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DE8018	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	011VJ	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1457452583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGO A TETTAMANTI MD PA

Provider Business Mailing Address
First Line	:	2928 MAPLEWOOD AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4021
Country	:	US
Telephone Number	:	336-760-4846
Fax Number	:	336-760-6462

Provider Business Practice Location Address
First Line	:	2928 MAPLEWOOD AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4021
Country	:	US
Telephone Number	:	336-760-4846
Fax Number	:	336-760-6462

Authorized Official
Title or Position	:	OWNER
Name	:	HUGO A TETTAMANTI
Credential	:	M.D.
Telephone Number	:	336-760-4846

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/24/2007

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Directions to “HUGO A TETTAMANTI MD PA ” Practice Location

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