Dr. Jennifer Marie Defazio
Procedural Dermatology
517 Moye Blvd
Greenville
, North Carolina 27834-2849
Dr. Jennifer Marie Defazio
Procedural Dermatology
517 Moye Blvd
Greenville
, North Carolina 27834-2849
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About
Features
Specialties
- Procedural Dermatology
Languages spoken
- English
Location
First Address
- Dr. Jennifer Marie Defazio
- Po Box 751069
- Charlotte, NC
- Zip : 28275-1069
- Phone :
Second Address
- Dr. Jennifer Marie Defazio
- 517 Moye Blvd
- Greenville, NC
- Zip : 27834-2849
- Fax : (252) 744-2096
- Phone : (252) 744-3109
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207NS0135X | Procedural Dermatology | 2009-01325 | NC |
| N | 207NS0135X | Procedural Dermatology | 22380 | WV |
National Provider Identifier
| NPI | 1508988742 |
|---|---|
| Provider Name | Dr. Jennifer Marie Defazio |
| First Address | Charlotte, NC 28275-1069 |
| Second Address | Greenville, NC 27834-2849 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/04/2007 |
| Last Update Date | 03/12/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 153RU | BCBSNC (01) | NC |
| 5912475 | (05) | NC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.