Provider Demographics
NPI:1306959705
Name:KANELOS, DINO PETER (MD)
Entity type:Individual
Prefix:DR
First Name:DINO
Middle Name:PETER
Last Name:KANELOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11220 ELM LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0715
Mailing Address - Country:US
Mailing Address - Phone:704-847-4000
Mailing Address - Fax:704-847-4001
Practice Address - Street 1:11220 ELM LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0715
Practice Address - Country:US
Practice Address - Phone:704-847-4000
Practice Address - Fax:704-847-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9801330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454040Medicare ID - Type Unspecified
NCH54012Medicare UPIN