Healthcare Provider Details

I. General information

NPI: 1013912229
Provider Name (Legal Business Name): MICHAEL MUNDY WARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 CANTERWOOD DR
WILMINGTON NC
28401-7301
US

IV. Provider business mailing address

2612 SHANDY LN
WILMINGTON NC
28409-2027
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-4600
  • Fax: 910-762-9483
Mailing address:
  • Phone: 910-350-0347
  • Fax: 910-350-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24552
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24552
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24552
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: