Provider Demographics
NPI:1538158910
Name:SONNINO, VICTOR G (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:G
Last Name:SONNINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VITTORIO
Other - Middle Name:G
Other - Last Name:SONNINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3361
Mailing Address - Country:US
Mailing Address - Phone:252-335-9900
Mailing Address - Fax:252-335-9920
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3361
Practice Address - Country:US
Practice Address - Phone:252-335-9900
Practice Address - Fax:252-335-9920
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001537207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
130023371OtherRR MCARE / PALMETTO GBA
NC1273XOtherBCBS
NC891273XMedicaid
130023371OtherRR MCARE / PALMETTO GBA
2282116BMedicare ID - Type Unspecified