Provider Demographics
NPI:1629132311
Name:WOLONICK FAMILY PRACTICE, P.A.
Entity Type:Organization
Organization Name:WOLONICK FAMILY PRACTICE, P.A.
Other - Org Name:RICHARD C. WOLONICK, D.O., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLONICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:910-277-8044
Mailing Address - Street 1:106 MCALPINE LANE
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 MCALPINE LANE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4637
Practice Address - Country:US
Practice Address - Phone:910-277-8044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891155MMedicaid
SCNPA806Medicaid
NC1155MOtherPERSONAL BLUECROSS #
NCFH1001400OtherFIRST CAROLINA CARE
NC0144NOtherBLUECROSS OF NC GROUP
SCN01899Medicaid
NC1005846001OtherCIGNA ID
NC790144NMedicaid
NCP00115379OtherMEDICARE RAILROAD
NC1155MOtherPERSONAL BLUECROSS #
NCP00115379OtherMEDICARE RAILROAD