Provider Demographics
NPI:1174595524
Name:WEGENER, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WEGENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PROFESSIONAL PARK
Mailing Address - Street 2:STE C
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2501
Mailing Address - Country:US
Mailing Address - Phone:919-603-0368
Mailing Address - Fax:919-603-0842
Practice Address - Street 1:97 NC-125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-1933
Practice Address - Fax:252-537-1936
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902194Medicaid
G07557Medicare UPIN
NC5902194Medicaid