Basic Information
| Provider Information | |||||||||
| NPI: | 1831168202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCAGLIONE | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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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: | 03/16/2006 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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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 | 200800822 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0007X | 200800822 | NC | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck |
ID Information
| ID | Type | State | Issuer | Description | 2008-00822 | 01 | NC | NC MEDICAL BOARD | OTHER |