Provider Demographics
NPI:1679599963
Name:LOPICCOLO, JOHN VITO (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VITO
Last Name:LOPICCOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 NORTH 35TH STREET
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-247-3256
Mailing Address - Fax:252-808-3183
Practice Address - Street 1:302 NORTH 35TH STREET
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-247-3256
Practice Address - Fax:252-808-3183
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC444213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08070OtherBCBS
NC89087UMedicaid
U89685Medicare UPIN
NC89087UMedicaid
NCP00038118Medicare PIN