MEDICARE: SAMUEL M WESONGA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	93-00369	NC
2	207Q00000X	Family Medicine Physician	9300369	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80084731	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	59381	OTHER	NC	MEDCOST
4	86588	OTHER	NC	BCBSNC
5	5497949	OTHER	NC	CIGNA HEALTHCARE

General Provider Information

NPI Number	:	1114911823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL M WESONGA MD

Provider Business Mailing Address
First Line	:	2920 HIGHWOODS BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-0010
Country	:	US
Telephone Number	:	877-498-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 T W ALEXANDER DR STE 216
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4884
Country	:	US
Telephone Number	:	919-350-0953
Fax Number	:	193-509-8189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	04/14/2021

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Directions to “ SAMUEL M WESONGA MD” Practice Location

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