Provider Demographics
NPI:1447256946
Name:WYNIA, VIRGIL H (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:H
Last Name:WYNIA
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 1:3000 NEW BERN AVE
Mailing Address - Street 2:STE 1200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-231-6132
Mailing Address - Fax:919-231-6276
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:STE 1200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-231-6132
Practice Address - Fax:919-231-6276
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19096207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989616Medicaid
060035475OtherRAILROAD MEDICARE
211-730Medicare ID - Type Unspecified
C87306Medicare UPIN