Provider Demographics
NPI:1619073590
Name:WADON, CAROL M (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:WADON
Suffix:
Gender:F
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 9788
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9788
Mailing Address - Country:US
Mailing Address - Phone:910-295-0215
Mailing Address - Fax:910-215-0218
Practice Address - Street 1:5 FIRST VLG
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8724
Practice Address - Country:US
Practice Address - Phone:910-295-0215
Practice Address - Fax:910-295-0218
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37968207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85166OtherBLUE CROSS BLUE SHIELD
NCFH2967595OtherFIRSTCAROLINA CARE
NC8985166Medicaid
NCFH2967595OtherFIRSTCAROLINA CARE
NC2142580AMedicare PIN