Provider Demographics
NPI:1851321822
Name:WEGENER, ADAM D (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WEGENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1423 E FRANKLIN ST STE D
Mailing Address - Street 2:DOVE INTERNAL MEDICINE
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5100
Mailing Address - Country:US
Mailing Address - Phone:704-289-6474
Mailing Address - Fax:704-289-2355
Practice Address - Street 1:1423 E FRANKLIN ST STE D
Practice Address - Street 2:DOVE INTERNAL MEDICINE
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5100
Practice Address - Country:US
Practice Address - Phone:704-289-6474
Practice Address - Fax:704-289-2355
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9601519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986381Medicaid
NC86381OtherBC BS NC
NC2234843Medicare ID - Type Unspecified
NC8986381Medicaid
NC2234843AMedicare ID - Type UnspecifiedDOVE IM(UPN)
SCN01519Medicare ID - Type Unspecified