Provider Demographics
NPI:1881740090
Name:DORNIC, DEMETRIAN IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIAN
Middle Name:IVAN
Last Name:DORNIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:DORNIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3701 NW CARY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8431
Mailing Address - Country:US
Mailing Address - Phone:919-467-9955
Mailing Address - Fax:919-467-2544
Practice Address - Street 1:3701 NW CARY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8431
Practice Address - Country:US
Practice Address - Phone:919-467-9955
Practice Address - Fax:919-467-2544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800513207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891183HMedicaid
NC89128E2Medicaid
NC2254285DMedicare ID - Type UnspecifiedPERFORMING PROVIDER #
NC89128E2Medicaid
NCG81125Medicare UPIN