Basic Information
| Provider Information | |||||||||
| NPI: | 1114907656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IGLESIAS | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNC FAMILY PRACTICE CTR | ||||||||
| Address2: | CB #7595 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199663711 | ||||||||
| FaxNumber: | 9199666125 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275996119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199663711 | ||||||||
| FaxNumber: | 9199666125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A92672 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 200900657 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2009-00657 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A926720 | 05 | CA | MEDICAID |