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NPI Code Detail

MEDICARE: DR. BRIAN EDWARD WYSONG MD

MEDICARE: DR. BRIAN EDWARD WYSONG 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
1207Q00000XFamily Medicine Physician2006-00934NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912930009
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN EDWARD WYSONG MD
Provider Business Mailing Address
First Line : 2550 COURT DR STE 201
Second Line :
City : GASTONIA
State : NC
Zip : 28054-2152
Country : US
Telephone Number : 704-867-1402
Fax Number : 704-671-2661
Provider Business Practice Location Address
First Line : 2290 REMOUNT RD
Second Line :
City : GASTONIA
State : NC
Zip : 28054-4725
Country : US
Telephone Number : 704-867-1402
Fax Number : 888-720-2814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 11/14/2023

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Directions to “ DR. BRIAN EDWARD WYSONG MD” Practice Location

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