Provider Demographics
NPI:1770546541
Name:WAYNE UROLOGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:WAYNE UROLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-735-1635
Mailing Address - Street 1:1112 GRACIE PLACE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2260
Mailing Address - Country:US
Mailing Address - Phone:919-735-1635
Mailing Address - Fax:919-735-6699
Practice Address - Street 1:1112 GRACIE PLACE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2260
Practice Address - Country:US
Practice Address - Phone:919-735-1635
Practice Address - Fax:919-735-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208800000X208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902910Medicaid
NCG53828Medicare UPIN
NCC86897Medicare UPIN
NCG55112Medicare UPIN
NC230279Medicare ID - Type UnspecifiedGROUP NUMBER
NC8902910Medicaid