Healthcare Provider Details

I. General information

NPI: 1316267149
Provider Name (Legal Business Name): BENJAMIN DAVID WIEGAND PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 HENDERSONVILLE RD STE 51
ASHEVILLE NC
28803-2349
US

IV. Provider business mailing address

PO BOX 360
SYLVA NC
28779-0360
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-9199
  • Fax: 828-692-2487
Mailing address:
  • Phone: 828-587-6312
  • Fax: 828-586-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: