Provider Demographics
NPI:1457794927
Name:MARCELLINO, AMANDA JO LOTT (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA JO
Middle Name:LOTT
Last Name:MARCELLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3509 OLD BATTLEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2419
Mailing Address - Country:US
Mailing Address - Phone:336-438-2148
Mailing Address - Fax:336-698-3832
Practice Address - Street 1:3509 OLD BATTLEGROUND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2419
Practice Address - Country:US
Practice Address - Phone:336-438-2148
Practice Address - Fax:336-698-3832
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201600327207Y00000X
NC2016-00327207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty