Doctor Name: | MR. O'LAF SORENTO MASSENBURG |
NPI Number: | 1013114701 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 101117 |
Business Practice Address: | 2337 Winterhaven Lane Winston-salem, NC - 271036792 |
Business Phone Number: | 3367608999 |
Business Fax Number: | 3366597027 |
Mailing Address: | 1309 Lees Chapel Road, GREENSBORO |
State: | NC |
Postal Code: | 274552601 |
Phone Number: | 3362865505 |
Fax Number: | 3362865583 |
NPI Enumeration Date: | 06/27/2007 |
NPI Last Update Date: | 07/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 101117 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |