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NPI Code Detail

MEDICARE: MR. WAYNE PAUL TAMBERELLI PA-C

MEDICARE: MR. WAYNE PAUL TAMBERELLI PA-C
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
1363AM0700XMedical Physician Assistant000100379NC
2363A00000XPhysician Assistant000100379NC

General Provider Information

NPI Number : 1891829156
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WAYNE PAUL TAMBERELLI PA-C
Provider Business Mailing Address
First Line : 107 W NASHVILLE DR STE A
Second Line :
City : NASHVILLE
State : NC
Zip : 27856-1289
Country : US
Telephone Number : 252-822-3583
Fax Number :
Provider Business Practice Location Address
First Line : 107 W NASHVILLE DR STE A
Second Line :
City : NASHVILLE
State : NC
Zip : 27856-1289
Country : US
Telephone Number : 252-822-3583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 01/04/2024

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