Provider Demographics
NPI:1831255009
Name:GOINS, WENDELL AUBREY (MD)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:AUBREY
Last Name:GOINS
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 1:9336 BLAKENEY CENTRE DR
Mailing Address - Street 2:STE 100B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6666
Mailing Address - Country:US
Mailing Address - Phone:704-759-1770
Mailing Address - Fax:704-759-1760
Practice Address - Street 1:9336 BLAKENEY CENTRE DR
Practice Address - Street 2:STE 100B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6666
Practice Address - Country:US
Practice Address - Phone:704-759-1770
Practice Address - Fax:704-759-1760
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17278208600000X
NC94-01199208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1395JOtherBLUE CROSS BLUE SHIELD
SC172789Medicaid
SC020050993OtherRAILROAD MEDICARE
SC172789Medicaid
SCF025307065Medicare PIN
SC020050993OtherRAILROAD MEDICARE