Basic Information
| Provider Information | |||||||||
| NPI: | 1033108980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DZIADZIOLA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | KENNETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 AMALIA ST NE STE 1 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953255 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 645 AMALIA ST NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953255 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 9700538 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.