Provider Demographics
NPI:1073510046
Name:WOOLWINE, NATHAN ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ASHLEY
Last Name:WOOLWINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37938
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28237-7938
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:433 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2405
Practice Address - Country:US
Practice Address - Phone:704-786-7770
Practice Address - Fax:704-971-0035
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400782207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE3298OtherMEDCOST PROVIDER
NC5902823Medicaid
NCP00194087OtherRR MCARE
NC805293OtherPARTNERS MEDICARE
NC7222609OtherAETNA PROVIDER
NC1398ROtherBCBS PROVIDER
NC4504731OtherCIGNA HEALTHCARE
NCNCA567AMedicare PIN
NCP00194087OtherRR MCARE