Provider Demographics
NPI:1568552891
Name:WOLINSKY, SIDNEY P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:P
Last Name:WOLINSKY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3433
Mailing Address - Country:US
Mailing Address - Phone:910-433-9004
Mailing Address - Fax:910-433-9001
Practice Address - Street 1:513 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3433
Practice Address - Country:US
Practice Address - Phone:910-433-9004
Practice Address - Fax:910-433-9001
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC100024207Q00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901613Medicaid
NC5901613Medicaid
NC2746544CMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
NC203276163OtherTAX ID NUMBER
NC2348124Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER