MEDICARE: DR. ROBERT CHARLES WINGATE DPM

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	213ES0131X	Foot Surgery Podiatrist	176	NC
2	213EP1101X	Primary Podiatric Medicine Podiatrist	176	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08197	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568542181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES WINGATE DPM

Provider Business Mailing Address
First Line	:	1050 SOUTH PEACE HAVEN ROAD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103
Country	:	US
Telephone Number	:	336-766-3338
Fax Number	:	336-766-3990

Provider Business Practice Location Address
First Line	:	1050 SOUTH PEACE HAVEN ROAD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-9788
Country	:	US
Telephone Number	:	336-766-3338
Fax Number	:	336-766-3990

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/26/2019

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