MR. WYLDER FONDAW (NPI# 1205450400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205450400 |
| Entity Type | Individual |
| Full Name | MR. WYLDER FONDAW |
| Credential | PA |
| Practice Address |
1126 N Church St Greensboro NC 27401-1000 |
| Mailing Address |
1601 Seward Dr Johnson City TN 37604-7143 |
| Practice Telephone | 3368327000 |
| Mailing Telephone | 8282313564 |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1126 N CHURCH ST |
| City | GREENSBORO |
| State | NC |
| Zip Code | 27401-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841281631 | Bertrand Diagnostic Imaging and Breast Center, Inc. | Specialist | 1126 N Church St, Suite 103, Greensboro, NC 27401-1000 | 2005-11-02 |
| 1023591807 | Jill Mcdaniel | Nurse Practitioner | 1126 N Church St, Greensboro, NC 27401-1000 | 2018-09-08 |
| 1730638685 | Megan E Supple | Pharmacist | 1126 N Church St, Ste 300, Greensboro, NC 27401-1000 | 2016-10-03 |
| 1215387279 | Brittany Manning Strader | Physician Assistant | 1126 N Church St, Suite 300, Greensboro, NC 27401-1000 | 2016-06-20 |
| 1275992992 | Bhavin Bhagat | Physician Assistant | 1126 N Church St, Suite 300, Greensboro, NC 27401-1000 | 2016-02-23 |
| 1649637778 | Amber Seiler | Nurse Practitioner | 1126 N Church St, Greensboro, NC 27401-1000 | 2016-01-20 |
| 1871960005 | Britney Ravenel | Nurse Anesthetist, Certified Registered | 1126 N Church St, Greensboro, NC 27401-1000 | 2015-08-24 |
| 1033523709 | Moses Cone Affiliated Physicians | Internal Medicine | 1126 N Church St, Suite 300, Greensboro, NC 27401-1000 | 2014-06-20 |
| 1922441773 | Cornerstone Health Care, LLC | Surgery | 1126 N Church St, Greensboro, NC 27401-1000 | 2013-04-11 |
| 1720336381 | Jessica Ann Hope | Physician Assistant | 1126 N Church St, Suite 300, Greensboro, NC 27401-1000 | 2012-08-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639779655 | Warfair Counseling, Consulting, & Supervision, Pllc | Counselor | 301 South Elm Street, Suite 801, Greensboro, NC 27401 | 2020-10-28 |
| 1225636848 | Alma Lucero Diaz | Registered Nurse | 1121 North Church St, Greensboro, NC 27401 | 2020-10-15 |
| 1447865217 | Rebecca Levy | Marriage & Family Therapist | Cone Health Family Medicine 1125 N Church Street, Greensboro, NC 27401 | 2020-09-09 |
| 1346854304 | Rayna's Home Care, LLC | Registered Nurse | 823 North Elm Street, Greensboro, NC 27401 | 2020-09-06 |
| 1316574718 | Garrett Green | Physician Assistant | 1121 N Church St., Greensboro, NC 27401 | 2020-03-25 |
| 1629635685 | Lauren Robinson Byrd | Anesthesiology | 1200 North Church St, Greensboro, NC 27401 | 2019-05-24 |
| 1285103069 | Shannon Marie Childs Meyerhoff | Occupational Therapist | Guilford County Schools Ec, 134 Franklin Blvd, Greensboro, NC 27401 | 2018-11-21 |
| 1194293241 | Ashley Marie Smith | Nurse Practitioner | 1200 North Elm St, Greensboro, NC 27401 | 2018-11-07 |
| 1285117762 | Anastazia Juszczak Gray | Speech-Language Pathologist | 1131 N. Church St, Greensboro, NC 27401 | 2018-09-11 |
| 1619474012 | Jamie Hannah Rose Aldridge | Psychiatry & Neurology | 1121 N Church Street, Greensboro, NC 27401 | 2018-04-11 |
| Find all providers in zip 27401 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497996805 | Mark Ellis Hepler | Physician Assistant | 3625 N Elm St Ste 110a, Greensboro, NC 27455 | 2009-03-13 |
| 1700869856 | Arlo C. Lassen | Physician Assistant | 1309 N Elm St, Greensboro, NC 27401-1005 | 2005-11-22 |
| 1417955410 | Matthew Lloyd Strupp | Physician Assistant | 1000 Spring Garden Street, Anna Gove Student Health Center, Greensboro, NC 27402-6170 | 2005-07-13 |
| 1255968376 | Cadence Hilary Furth | Physician Assistant | 1126 N Church St Ste 300, Greensboro, NC 27401-1037 | 2020-03-26 |
| 1386284305 | Margaux Venter | Physician Assistant | 1121 N Church St, Greensboro, NC 27401 | 2020-01-07 |
| 1275095499 | Brandon Anthony Morelli | Physician Assistant | 1200 N Elm St, Greensboro, NC 27401-1004 | 2019-04-05 |
| 1952875288 | Alexandra Marie Louk | Physician Assistant | 1331 N Elm St Ste 200, Greensboro, NC 27401-6304 | 2019-01-21 |
| 1932605862 | Sophia Caccavale | Physician Assistant | 1200 N Elm St, Greensboro, NC 27401-1004 | 2018-03-31 |
| 1902348667 | Kelly Gekas | Physician Assistant | 1200 N Elm St, Greensboro, NC 27401-1004 | 2016-11-12 |
| 1497108930 | Ellyn Mcginnis | Physician Assistant | 7 Glassworks Rd, Greensboro, PA 15338-9507 | 2016-07-20 |
| Find all providers in GREENSBORO | ||||
| City | GREENSBORO |
| Zip Code | 27401 |
Please comment or provide details below to improve the information on MR. WYLDER FONDAW.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.