Provider Demographics
NPI:1124441654
Name:TONY MAGLIONE MD,PLLC
Entity type:Organization
Organization Name:TONY MAGLIONE MD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-397-0626
Mailing Address - Street 1:417 JOHN S MOSBY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2032 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6677
Practice Address - Country:US
Practice Address - Phone:910-202-1071
Practice Address - Fax:910-343-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00625207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953716Medicaid
NC2227891DMedicare PIN
NCA63767Medicare UPIN
NC2227891FMedicare PIN