Healthcare Provider Details

I. General information

NPI: 1205947009
Provider Name (Legal Business Name): EDGAR O HORGER IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 WELLINGTON AVE SUITE E
WILMINGTON NC
28401-7747
US

IV. Provider business mailing address

1606 WELLINGTON AVE SUITE E
WILMINGTON NC
28401-7747
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-1999
  • Fax: 910-452-1883
Mailing address:
  • Phone: 910-452-1999
  • Fax: 910-452-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35374
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8943705
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: