Healthcare Provider Details

I. General information

NPI: 1326000316
Provider Name (Legal Business Name): WIRT NEALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 EAST BLVD SUITE 280
CHARLOTTE NC
28203-5975
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1866
  • Fax: 704-384-1867
Mailing address:
  • Phone: 704-384-7840
  • Fax: 704-316-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: