Provider Demographics
NPI:1578586541
Name:WISE, BARBARA V (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:V
Last Name:WISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:711 EXECUTIVE PL FL 4
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5193
Practice Address - Country:US
Practice Address - Phone:910-615-3333
Practice Address - Fax:910-615-9765
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM14062084P0800X
NC2006-011242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00947336OtherRR MCR
TX280608501Medicaid
TX8CV358OtherBCBS TX
NC5907197Medicaid
NC2061319Medicare PIN
NC5907197Medicaid