Individual
RUSSELL ANTHONY INCATASCIATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4402 SHIPYARD BLVD, WILMINGTON, NC 28403-6161
(910) 452-1400
(910) 791-9626
Mailing address
4402 SHIPYARD BLVD, WILMINGTON, NC 28403-6161
(910) 452-1400
(910) 791-9626
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9900882
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1199V
BCBS
NC
05
—
891199V
—
NC
01
—
P00374412
RAILROAD MEDICARE
NC
05
—
Q09872
—
SC
Enumeration date
10/10/2006
Last updated
11/24/2009
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