Provider Demographics
NPI:1629043328
Name:WIEGAND, PAUL HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HARRIS
Last Name:WIEGAND
Suffix:
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 15386
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0386
Mailing Address - Country:US
Mailing Address - Phone:919-477-5152
Mailing Address - Fax:919-477-5474
Practice Address - Street 1:3643 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2702
Practice Address - Country:US
Practice Address - Phone:919-470-5345
Practice Address - Fax:919-477-5474
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27340207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8987325Medicaid
NC87325OtherBLUE CROSS
NCCC1967OtherMEDICARE RAILROAD
NC930004282OtherMEDICARE RAILROAD
NCCC1967OtherMEDICARE RAILROAD
NC8987325Medicaid