Individual
DR. WALTER S FASOLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
145 APPLECROSS RD, SOUTHERN PINES WOMENS HEALTH CENTER PC, SOUTHERN PINES, NC 28387
(910) 692-7928
(910) 692-5962
Mailing address
PO BOX 749, SOUTHERN PINES WOMENS HEALTH CENTER PC, SOUTHERN PINES, NC 28388-0749
(910) 692-7928
(910) 692-5962
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
39728
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31369
BLUE CROSS BLUE SHIELD
—
01
—
42653
MEDCOST
—
05
—
8931369
—
NC
01
—
9663436
GHI
—
01
—
980000066
MEDICARE RAILROAD
—
01
—
FH1000115
FIRST CAROLINA CARE
—
05
—
Q39728
—
SC
Enumeration date
03/31/2006
Last updated
02/25/2010
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