Provider Demographics
NPI:1619085545
Name:DE MARIA, ALFRED (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:DE MARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2511 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6003
Mailing Address - Country:US
Mailing Address - Phone:910-772-9202
Mailing Address - Fax:866-345-8963
Practice Address - Street 1:1222 MEDICAL CENTER DR
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3383
Practice Address - Fax:910-341-3321
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC216412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928311Medicaid
NC28311OtherBCBS NC
NC130013806OtherRAILROAD MEDICARE
NCH13608Medicare UPIN
NC2180586GMedicare PIN
NC2180586DMedicare PIN