Provider Demographics
NPI:1730269002
Name:PEZZI, THOMAS A (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:PEZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5965
Mailing Address - Fax:828-757-5104
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:SUITE 202
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-757-6146
Practice Address - Fax:828-757-5944
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC20000935208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126VJMedicaid
NCNCD461C674Medicare PIN
G67364Medicare UPIN