Provider Demographics
NPI:1154355790
Name:BRITTO, ERROL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ERROL
Middle Name:JOHN
Last Name:BRITTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-6777
Mailing Address - Fax:336-718-6773
Practice Address - Street 1:1901 S HAWTHORNE RD STE 220
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-718-6777
Practice Address - Fax:336-718-6773
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099384208600000X
TNMD34999208600000X
NC2015-02091208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3863796Medicaid
TN3863796Medicaid
TN3863798Medicare PIN
H36206Medicare UPIN