Healthcare Provider Details

I. General information

NPI: 1679911879
Provider Name (Legal Business Name): NOAH WOUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 3RD ST
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

930 3RD ST
GREENSBORO NC
27405-6967
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-3200
  • Fax: 336-890-3290
Mailing address:
  • Phone: 336-890-3200
  • Fax: 336-890-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201600759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: