Provider Demographics
NPI:1891791752
Name:WINNEBERGER, THEODORE ROBISON (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ROBISON
Last Name:WINNEBERGER
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 1:1414 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7335
Mailing Address - Country:US
Mailing Address - Phone:910-796-8042
Mailing Address - Fax:
Practice Address - Street 1:1414 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7335
Practice Address - Country:US
Practice Address - Phone:910-796-8042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB4562OtherMEDCOST
SCN27345Medicaid
NC930077054OtherRAILROAD MEDICARE
NC88544OtherBCBS
NC930040266OtherRAILROAD MEDICARE
NC01-28850OtherUNITED HEALTHCARE
NC8988544Medicaid
NCB4562OtherMEDCOST
NC8988544Medicaid
SCN27345Medicaid