Individual
MR. CANIO THOMAS MARCANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2915 LYNDHURST AVE, WINSTON SALEM, NC 27103-4005
(336) 765-5221
(336) 765-0430
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103584
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8101544
—
NC
Enumeration date
03/22/2006
Last updated
06/08/2021
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