| Adolfo Richard Desandre, MD | |
|
257 Hospital Drive Suite 200, Bolivia, NC 28422-8411 | |
| (910) 721-4000 | |
| (910) 721-4001 |
| Full Name | Adolfo Richard Desandre |
|---|---|
| Gender | Male |
| Speciality | General Surgery |
| Experience | 44 Years |
| Location | 257 Hospital Drive Suite 200, Bolivia, North Carolina |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710963475 | NPI | - | NPPES |
| 20712 | Other | SC | SC MEDICAL LICENSE |
| 9801631 | Other | NC | NC MEDICAL LICENSE |
| 8911805 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 20712 (South Carolina) | Secondary |
| 208600000X | Surgery | 9801631 (North Carolina) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Novant Health Brunswick Medical Center | Supply, NC | Hospital |
| New Hanover Regional Medical Center | Wilmington, NC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Novant Health Medical Group, Llc | 1153234893 | 2144 |
| Entity Name | Novant Health Medical Group, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366409492 PECOS PAC ID: 1153234893 Enrollment ID: O20031121000692 |
| Entity Name | Brunswick Community Hospital Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669725198 PECOS PAC ID: 9335150895 Enrollment ID: O20130903000403 |
| Mailing Address | Practice Location Address |
|---|---|
| Adolfo Richard Desandre, MD Po Box 60447, Charlotte, NC 28260-0447 Ph: (704) 384-7840 | Adolfo Richard Desandre, MD 257 Hospital Drive Suite 200, Bolivia, NC 28422-8411 Ph: (910) 721-4000 |
Matt Aaron Benenati, DO Surgery Medicare: Accepting Medicare Assignments Practice Location: 257 Hospital Drive Suite 200, Bolivia, NC 28422 Phone: 910-721-4000 Fax: 910-721-4001 | |
Richard Ralph Scallion, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 257 Hospital Drive Suite 200, Bolivia, NC 28422 Phone: 910-721-4000 Fax: 910-721-4001 | |
Joseph Andrew Smith, Surgery Medicare: Accepting Medicare Assignments Practice Location: 257 Hospital Drive Suite 200, Bolivia, NC 28422 Phone: 910-721-4000 Fax: 910-721-4001 | |
Mark Tillotson, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 257 Hospital Drive Suite 200, Bolivia, NC 28422 Phone: 910-721-4000 Fax: 910-721-4001 |