Provider Demographics
NPI:1114900776
Name:CLINE, WAYNE ALLEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ALLEN
Last Name:CLINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-633-9441
Mailing Address - Fax:
Practice Address - Street 1:911 W HENDERSON ST
Practice Address - Street 2:STE 110
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2736
Practice Address - Country:US
Practice Address - Phone:704-633-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26095208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8923041Medicaid
NCC83268Medicare UPIN
NCNCP229AMedicare PIN
NC8923041Medicaid