Provider Demographics
NPI:1013912229
Name:WARD, MICHAEL MUNDY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MUNDY
Last Name:WARD
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 1:2612 SHANDY LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2027
Mailing Address - Country:US
Mailing Address - Phone:910-350-0347
Mailing Address - Fax:910-350-0347
Practice Address - Street 1:2215 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7301
Practice Address - Country:US
Practice Address - Phone:910-762-4600
Practice Address - Fax:910-762-9483
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24552207R00000X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ24552Medicaid
NC85742OtherBCBS
NC930077032OtherRAILROAD MEDICARE
NC01-28697OtherUNITED HEALTHCARE
NC930084661OtherRAILROAD MEDICARE
NC8985742Medicaid
NCB4560OtherMEDCOST
SCQ24552Medicaid
C87002Medicare UPIN
NC930084661OtherRAILROAD MEDICARE
NC01-28697OtherUNITED HEALTHCARE