Provider Demographics
NPI:1952569527
Name:MILLENNIA CARDIOVASCULAR, P.A.
Entity Type:Organization
Organization Name:MILLENNIA CARDIOVASCULAR, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEFALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-894-7553
Mailing Address - Street 1:101 E MARKET ST STE 1H
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3979
Mailing Address - Country:US
Mailing Address - Phone:919-209-9856
Mailing Address - Fax:919-209-9859
Practice Address - Street 1:101 E MARKET ST STE 1H
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3979
Practice Address - Country:US
Practice Address - Phone:919-209-9856
Practice Address - Fax:919-209-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31685207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-86305Medicaid
NC212875NMedicare PIN