Provider Demographics
NPI:1215191457
Name:DIAZ-ZAMORA, GIANCARLO MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:GIANCARLO
Middle Name:MARTIN
Last Name:DIAZ-ZAMORA
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 1:8300 HEALTH PARK STE 211
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4731
Mailing Address - Country:US
Mailing Address - Phone:919-769-6100
Mailing Address - Fax:919-322-0542
Practice Address - Street 1:8300 HEALTH PARK STE 211
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-769-6100
Practice Address - Fax:919-322-0542
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2024-08-26
Deactivation Date:2024-08-12
Deactivation Code:
Reactivation Date:2024-08-23
Provider Licenses
StateLicense IDTaxonomies
MI4301092269207R00000X
IA42489207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine