Provider Demographics
NPI:1972603231
Name:CITRON, MICHAEL O (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:CITRON
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 1:8308 NANTAHALA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7336
Mailing Address - Country:US
Mailing Address - Phone:919-571-8137
Mailing Address - Fax:
Practice Address - Street 1:8406 SIX FORKS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3074
Practice Address - Country:US
Practice Address - Phone:919-740-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500043207P00000X
NC95-00043208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080094382OtherRR MEDICARE
NC8922602Medicaid
NC69637OtherBLUE SHIELD
NC8969637Medicaid
NC8969637Medicaid
NC8969637Medicaid
NC2225483BMedicare PIN
NC8969637Medicaid