Provider Demographics
NPI:1578708756
Name:HARP, WAYNE J JR (PA)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:J
Last Name:HARP
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1535
Mailing Address - Country:US
Mailing Address - Phone:704-334-6370
Mailing Address - Fax:
Practice Address - Street 1:1008 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1535
Practice Address - Country:US
Practice Address - Phone:704-334-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC101599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101249Medicaid
NCNC2987AMedicare UPIN