# NEW HANOVER MEDICAL GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992751374
- **Authorized official:** MS. MARGO J ILLOBRE (BUSINESS OFFICE SUPERVISOR)
- **Authorized official phone:** (910) 343-9991

## Contact information

- **Practice address:** 1960 S 16TH ST, WILMINGTON, NC 28401-6647
- **Practice address phone:** (910) 343-9991
- **Mailing address:** 1960 S 16TH ST, WILMINGTON, NC 28401-6647
- **Mailing address phone:** (910) 343-9991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 41057 | NC | Yes |
| 207R00000X | Internal Medicine Physician | 41057 | NC | — |
| 2085B0100X | Body Imaging Physician | — | NULL | — |
| 2085B0100X | Body Imaging Physician | — | — | — |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 11/11/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 890218J | — | NC |