MEDICARE: DR. BARBARA V. WISE M.D.

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	2084P0800X	Psychiatry Physician	M1406	TX
2	2084P0800X	Psychiatry Physician	2006-01124	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00947336	OTHER	TX	RR MCR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8CV358	OTHER	TX	BCBS TX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578586541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA V. WISE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 40908
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-0908
Country	:	US
Telephone Number	:	910-615-6949
Fax Number	:	910-615-9761

Provider Business Practice Location Address
First Line	:	711 EXECUTIVE PL FL 4
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5193
Country	:	US
Telephone Number	:	910-615-3333
Fax Number	:	910-615-9765

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/08/2024

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Directions to “ DR. BARBARA V. WISE M.D.” Practice Location

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