Healthcare Provider Details

I. General information

NPI: 1760485726
Provider Name (Legal Business Name): RICHARD C WOLONICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PAGE RD
PINEHURST NC
28374-8798
US

IV. Provider business mailing address

205 PAGE RD
PINEHURST NC
28374-8798
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-4011
  • Fax: 910-420-1612
Mailing address:
  • Phone: 910-692-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97-01899
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: