Basic Information
| Provider Information | |||||||||
| NPI: | 1760485726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLONICK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 MCALPINE LANE | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283524637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102778044 | ||||||||
| FaxNumber: | 9102770036 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 MCALPINE LN | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283524637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102778044 | ||||||||
| FaxNumber: | 9102770036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 97-01899 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 891155M | 05 | NC | MEDICAID | FH1001400 | 01 | NC | FIRST CAROLINA CARE | OTHER | NPA806 | 05 | SC | MEDICAID | 0144N | 01 | NC | BLUECROSS OF NC GROUP | OTHER | 1155M | 01 | NC | PERSONAL BLUECROSS # | OTHER | 790144N | 05 | NC | MEDICAID | N01899 | 05 | SC | MEDICAID | 1005846001 | 01 | NC | CIGNA ID | OTHER | P00115379 | 01 | NC | MEDICARE RAILROAD | OTHER |