Provider Demographics
NPI:1679543870
Name:WESTRA, IGOR (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:WESTRA
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 1:1801 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-254-2023
Mailing Address - Fax:910-254-0242
Practice Address - Street 1:1801 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-254-2023
Practice Address - Fax:910-254-0242
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300370207WX0107X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01315OtherBCBS NORTH CAROLINA
NC790129CMedicaid
NC86648OtherBCBS NORTH CAROLINA
NC8986648Medicaid
SCQ00370Medicaid
SCQPA675Medicaid
180038153OtherRR MEDICARE
NC2344447AMedicare ID - Type UnspecifiedGROUP
NC8986648Medicaid
NC2186544BMedicare ID - Type Unspecified
SCQ00370Medicaid