Healthcare Provider Details

I. General information

NPI: 1851316640
Provider Name (Legal Business Name): WAYNE HEART & INTERNAL MEDICINE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9460
US

IV. Provider business mailing address

2704 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9460
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-4724
  • Fax: 919-736-4721
Mailing address:
  • Phone: 919-736-4724
  • Fax: 919-736-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAGMOHAN D GUPTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-736-4724