Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 25796 | NC |
NPI | 1013083146 |
---|---|
Provider Name | Dr. Lionel Gregory Fernando |
First Address | Wilmington, NC 28408-6310 |
Second Address | Wilmington, NC 28409-2966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31705 | BLUE CROSS BLUE SHIELD (01) | NC |
8931711 | (05) | NC |
E01654 | (02) | NC |