Provider Demographics
NPI:1396745881
Name:STANZIONE, MICHOL (DO)
Entity type:Individual
Prefix:
First Name:MICHOL
Middle Name:
Last Name:STANZIONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PAVILION WAY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2224
Practice Address - Country:US
Practice Address - Phone:910-246-4140
Practice Address - Fax:910-695-2192
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905676Medicaid
NC8900379OtherEVERCARE PROVIDER #
NC197551OtherMEDCOST PROVIDER #
NC14430OtherBCBS NC PROVIDER #
NCFH1100260OtherFIRSTCAROLINACARE #
SCN01814OtherSC MEDICAID PROVIDER #
NCFH1100260OtherFIRSTCAROLINACARE #
NCP00411559Medicare PIN
NC197551OtherMEDCOST PROVIDER #