Provider Demographics
NPI:1376436378
Name:WINGATE PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:WINGATE PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-505-0355
Mailing Address - Street 1:305 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1735
Mailing Address - Country:US
Mailing Address - Phone:610-505-0355
Mailing Address - Fax:
Practice Address - Street 1:266 LANCASTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3256
Practice Address - Country:US
Practice Address - Phone:610-813-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty