MEDICARE: MICHAEL T WINGATE 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	208600000X	Surgery Physician	MD446948	PA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477546950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T WINGATE MD

Provider Business Mailing Address
First Line	:	145 HOSPITAL AVE
Second Line	:	SUITE 313
City	:	DU BOIS
State	:	PA
Zip	:	15801-1462
Country	:	US
Telephone Number	:	814-375-4000
Fax Number	:	814-375-4011

Provider Business Practice Location Address
First Line	:	100 HOSPITAL AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-1440
Country	:	US
Telephone Number	:	814-375-6560
Fax Number	:	814-372-2848

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/15/2017

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