Healthcare Provider Details

I. General information

NPI: 1003821547
Provider Name (Legal Business Name): WILMINGTON SURGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 IRON GATE DR
WILMINGTON NC
28412-3731
US

IV. Provider business mailing address

2739 IRON GATE DR
WILMINGTON NC
28412-3731
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-7363
  • Fax: 910-251-8296
Mailing address:
  • Phone: 910-763-7363
  • Fax: 910-251-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHAD MARTIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 910-763-7363