| Wagram Family Practice | |
|
24420 Marlboro Street Wagram NC 28396-9600 | |
| (919) 369-3136 | |
| (910) 369-4756 |
| Full Name | Wagram Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 24420 Marlboro Street, Wagram, North Carolina |
| Authorized Official Name and Position | Mathew David Pracht (TREASURER) |
| Authorized Official Contact | 9102917920 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagram Family Practice Po Box 602458 Charlotte NC 28260-2458 Ph: (910) 369-3136 | Wagram Family Practice 24420 Marlboro Street Wagram NC 28396-9600 Ph: (919) 369-3136 |
| NPI Number | 1982913422 |
|---|---|
| Provider Enumeration Date | 10/01/2010 |
| Last Update Date | 01/11/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982913422 | NPI | - | NPPES |
| NPB433 | Medicaid | SC | |
| 1982913422 | Medicaid | NC | |
| 5916876 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Wagram Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 24420 Marlboro St, Wagram, NC 28396 Phone: 910-369-3136 Fax: 910-369-4756 |