Provider Demographics
NPI:1134112717
Name:MCELLIGOTT, JACINTA M (MD)
Entity type:Individual
Prefix:DR
First Name:JACINTA
Middle Name:M
Last Name:MCELLIGOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:REGIONAL REHABILITATION CENTER - PCMH
Practice Address - Street 2:2100 STANTONSBURG ROAD
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-744-2207
Practice Address - Fax:252-744-6625
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33092208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8956486Medicaid
NC56486OtherBCBS NC
NCC30079Medicare UPIN
NC8956486Medicaid