Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20137 | NC |
Y | 207QA0505X | Family Doctor - Adult Medicine | 20137 | NC |
NPI | 1164480455 |
---|---|
Provider Name | Antonia Rosario Tettamanti |
First Address | Winston Salem, NC 27103-4109 |
Second Address | Winston Salem, NC 27103-4109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 23/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0109922 | UNITED HEALTHCARE (01) | NC |
82441 | BCBSNC (01) | NC |
8982441 | (05) | NC |
E00426 | (02) | NC |
P00317035 | RAILROAD MEDICARE (01) | NC |