Provider Demographics
NPI:1144330879
Name:FESPERMAN, JOSEPH C (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:FESPERMAN
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-667-0938
Practice Address - Street 1:1534 WEST D STREET
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-667-0938
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC206266JOtherMEDICARE, INDIVIDUAL PTAN
NC8931753Medicaid
NC206266HMedicare PIN