| Wilmington Internal Medicine Pa | |
|
2215 Canterwood Dr Wilmington NC 28401-7301 | |
| (910) 762-4600 | |
| (910) 762-9483 |
| Full Name | Wilmington Internal Medicine Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 2215 Canterwood Dr, Wilmington, North Carolina |
| Authorized Official Name and Position | Wendy Michelle Young (PRACTICE MANAGER) |
| Authorized Official Contact | 9107624600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilmington Internal Medicine Pa 2215 Canterwood Dr Wilmington NC 28401-7301 Ph: (910) 762-4600 | Wilmington Internal Medicine Pa 2215 Canterwood Dr Wilmington NC 28401-7301 Ph: (910) 762-4600 |
| NPI Number | 1639201056 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 12/27/2012 |
| Medicare PECOS PAC ID | 9931270766 |
|---|---|
| Medicare Enrollment ID | O20080620000555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639201056 | NPI | - | NPPES |
| 7978365 | Medicaid | NC | |
| 0176C | Other | NC | BLUE CROSS PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 85716 (North Carolina) | Primary |
| Provider Name | Frank A Snyder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770563314 PECOS PAC ID: 3678644408 Enrollment ID: I20080620000543 |
| Provider Name | Kimberly Jean Salene |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124139373 PECOS PAC ID: 6103840939 Enrollment ID: I20090601000213 |
| Provider Name | Ian Foxall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528008109 PECOS PAC ID: 9830299205 Enrollment ID: I20131002000163 |
| Provider Name | Shannon Boney Mathis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013472232 PECOS PAC ID: 2264773894 Enrollment ID: I20190409002353 |
| Provider Name | Mackensie G De La Roca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134720766 PECOS PAC ID: 6901215441 Enrollment ID: I20210512002749 |
| Provider Name | Emily M Rhoades |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205529047 PECOS PAC ID: 9234599820 Enrollment ID: I20230713003691 |
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