Provider Demographics
NPI:1992701585
Name:DELUZIO, ANTONIO J (DO)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:J
Last Name:DELUZIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3824
Mailing Address - Country:US
Mailing Address - Phone:704-482-8223
Mailing Address - Fax:704-482-8230
Practice Address - Street 1:111 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3824
Practice Address - Country:US
Practice Address - Phone:704-482-8223
Practice Address - Fax:704-482-8230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135TCOtherBCBS ID #
NC89135TCMedicaid
NCH94838Medicare UPIN
NC89135TCMedicaid