1760485726 NPI number — DR. RICHARD C WOLONICK D.O. P.A.

Table of content: DR. RICHARD C WOLONICK D.O. P.A. (NPI 1760485726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760485726 NPI number — DR. RICHARD C WOLONICK D.O. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLONICK
Provider First Name:
RICHARD
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O. P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760485726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MCALPINE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAURINBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28352-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-277-8044
Provider Business Mailing Address Fax Number:
910-277-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MCALPINE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAURINBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28352-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-277-8044
Provider Business Practice Location Address Fax Number:
910-277-0036
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  97-01899 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 891155M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: FH1001400 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPA806 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0144N . This is a "BLUECROSS OF NC GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1155M . This is a "PERSONAL BLUECROSS #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 790144N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: N01899 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1005846001 . This is a "CIGNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P00115379 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com