MEDICARE: DAVID WISEMAN PA-C

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	174400000X	Specialist	102519	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	136YA	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1306987920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WISEMAN PA-C

Provider Business Mailing Address
First Line	:	201 COX BLVD
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9479
Country	:	US
Telephone Number	:	919-735-7580
Fax Number	:	919-580-9338

Provider Business Practice Location Address
First Line	:	201 COX BLVD
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9479
Country	:	US
Telephone Number	:	919-735-7580
Fax Number	:	919-580-9338

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/09/2012

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Directions to “ DAVID WISEMAN PA-C” Practice Location

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