Provider Demographics
NPI:1538192307
Name:LONDON, DEBORAH LOUISE (MD)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LOUISE
Last Name:LONDON
Suffix:
Gender:F
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 1052
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-1052
Mailing Address - Country:US
Mailing Address - Phone:828-228-8214
Mailing Address - Fax:
Practice Address - Street 1:2180 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3724
Practice Address - Country:US
Practice Address - Phone:828-464-7800
Practice Address - Fax:828-464-7825
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC193991OtherWELLPATH
NC52668OtherBCBS
NC8952668Medicaid
NC281230OtherMAMSI
NCA0887OtherMEDCOST
NC5200524OtherAETNA PPO
NC5369163OtherCIGNA
NC5200524OtherAETNA PPO
NC281230OtherMAMSI