Individual
MR. IRVING DAVID WIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1401 MATTHEWS TOWNSHIP PKWY, SUITE 101, MATTHEWS, NC 28105-5402
(704) 295-3550
(704) 295-3556
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
(704) 295-3468
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100635
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970023482
MEDICARE RR
—
01
—
98462
MEDCOST
NC
Enumeration date
10/18/2005
Last updated
12/09/2009
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