Provider Demographics
NPI:1760485726
Name:WOLONICK, RICHARD C (DO PA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:WOLONICK
Suffix:
Gender:M
Credentials:DO PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:910-277-8044
Mailing Address - Fax:910-277-0036
Practice Address - Street 1:106 MCALPINE LN
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:910-277-0036
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-01899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891155MMedicaid
NCFH1001400OtherFIRST CAROLINA CARE
SCNPA806Medicaid
NC0144NOtherBLUECROSS OF NC GROUP
NC1155MOtherPERSONAL BLUECROSS #
NC790144NMedicaid
SCN01899Medicaid
NC1005846001OtherCIGNA ID
NCP00115379OtherMEDICARE RAILROAD
NCP00115379OtherMEDICARE RAILROAD
NCFH1001400OtherFIRST CAROLINA CARE