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NPI Code Detail

MEDICARE: KENT JOSEPH NASTASI M. D.

MEDICARE: KENT JOSEPH NASTASI M. D.
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
1207K00000XAllergy & Immunology Physician9700683NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
22235190AOTHERNCMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588654750
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENT JOSEPH NASTASI M. D.
Provider Business Mailing Address
First Line : PO BOX 603725
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-3725
Country : US
Telephone Number : 828-575-2625
Fax Number : 828-350-2174
Provider Business Practice Location Address
First Line : 1372 WESTGATE CENTER DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-2932
Country : US
Telephone Number : 336-659-4814
Fax Number : 336-768-4745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 10/31/2023

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Directions to “ KENT JOSEPH NASTASI M. D.” Practice Location

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