Basic Information
| Provider Information | |||||||||
| NPI: | 1104842012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESSINA | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | FRANK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 SHIPYARD BLVD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284038023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107990110 | ||||||||
| FaxNumber: | 9107991958 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 SHIPYARD BLVD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284038023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107990110 | ||||||||
| FaxNumber: | 9107991958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 08/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9701064 | NC | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 8780209 | 01 | NC | CIGNA PROVIDER NUMBER | OTHER | 1040H | 01 | NC | BCBS OF NC PROVIDER NUMBE | OTHER | 0928871 | 01 | NC | UNITED HEALTHCARE | OTHER | 891040H | 05 | NC | MEDICAID |