Provider Demographics
NPI:1033108980
Name:DZIADZIOLA, JAMES KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:DZIADZIOLA
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 1:645 AMALIA ST NE STE 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2434
Mailing Address - Country:US
Mailing Address - Phone:704-295-3255
Mailing Address - Fax:
Practice Address - Street 1:645 AMALIA ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2434
Practice Address - Country:US
Practice Address - Phone:704-295-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700538207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC040010554OtherRAILROAD MEDICARE
NC123081OtherCIGNA
NC1041979OtherUNITED HEALTHCARE
NC20362685OtherAETNA
NC74998OtherMEDCOST
NC891066TMedicaid
NC22828OtherPARTNERS
NC123081OtherCIGNA
NCG57145Medicare UPIN