MEDICARE: DR. PAUL ANTHONY BUONGIORNO 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
1	2084P0800X	Psychiatry Physician	01189	NC
2	2084P0800X	Psychiatry Physician	34364	VA
3	2084P0800X	Psychiatry Physician	13002	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19910	OTHER	NC	BLUE CROSS BLUE SHIELD NC

General Provider Information

NPI Number	:	1821075805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ANTHONY BUONGIORNO M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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