Individual
OLGA IZOTOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 PAGE RD, PINEHURST, NC 28374-8749
(910) 295-5511
(910) 420-1611
Mailing address
205 PAGE RD, PINEHURST, NC 28374-8749
(910) 295-5511
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
2009-00246
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1526G
BC/BS NC
—
01
—
1532117
CIGNA HEALTHCARE PROVIDER#
—
01
—
218241
MEDCOST PROVIDER#
—
05
—
5911652
—
NC
01
—
N0024F
SC MEDICAID PROVIDER #
SC
01
—
N0024F
SC MEDICAID
—
01
—
P00726968
RAILROAD MEDICARE
—
Enumeration date
05/09/2007
Last updated
01/23/2018
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