Individual
DR. JENNIFER MARIE DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
517 MOYE BLVD, GREENVILLE, NC 27834-2849
(252) 744-3109
(252) 744-2096
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
2009-01325
NC
207NS0135X
Procedural Dermatology Physician
22380
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153RU
BCBSNC
NC
05
—
5912475
—
NC
Enumeration date
04/06/2007
Last updated
02/07/2024
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