MEDICARE: JOSEPH S WOLYNIAK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	9600781	NC
2	208D00000X	General Practice Physician	9600781	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053390856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH S WOLYNIAK DO

Provider Business Mailing Address
First Line	:	7004 SMITH CORNERS BLVD
Second Line	:	SUITE A
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3793
Country	:	US
Telephone Number	:	704-688-9650
Fax Number	:	704-688-9651

Provider Business Practice Location Address
First Line	:	7004 SMITH CORNERS BLVD
Second Line	:	SUITE A
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3793
Country	:	US
Telephone Number	:	704-688-9650
Fax Number	:	704-688-9651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	11/07/2011

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Directions to “ JOSEPH S WOLYNIAK DO” Practice Location

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