Basic Information
| Provider Information | |||||||||
| NPI: | 1104831858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOO | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | WESLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 COURT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048672141 | ||||||||
| FaxNumber: | 7048672308 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 COURT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048672141 | ||||||||
| FaxNumber: | 7048672308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME79393 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 2010-00546 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 276002900 | 05 | FL | MEDICAID | NC1125 | 05 | SC | MEDICAID | 1104831858 | 05 | NC | MEDICAID |