Individual
MARK DAVID IANNETTONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 HEART DR, GREENVILLE, NC 27834-8982
(252) 744-4400
(252) 744-3987
Mailing address
PO BOX 751069, ECU PHYSICIANS, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2014-01742
NC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35447
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0432120
—
IA
05
—
1164404976
—
NC
01
—
188J9
BCBS NC
NC
01
—
36310
WELLMARK BCBS
IA
Enumeration date
11/17/2005
Last updated
02/14/2024
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