Individual provider Active NPI

Paula Valeria Vergara-Wentland, M.D.

  • Diagnostic Radiology Physician
  • Winston Salem, NC
National Provider Identifier
1356623714
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
175542 Issued in NC
Practice address
455 Summergate Dr
Winston Salem, NC 27103-5538
Phone
(518) 250-8919
NPI assigned
Sep 12, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 175542 NC Primary

Addresses

Primary practice location

455 Summergate Dr
Winston Salem, NC 27103-5538

Mailing address

455 Summergate Dr.
Winston-Salem, NC 27103-3501
Phone (518) 250-8919

Other names 1

  • Paula Valeria Vergara Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
175542NCMDDiagnostic Radiology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1356623714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 SUMMERGATE DR.",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271033501",
            "telephone_number": "518-250-8919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 SUMMERGATE DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035538",
            "telephone_number": "518-250-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERGARA-WENTLAND",
        "first_name": "PAULA",
        "middle_name": "VALERIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-12",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "175542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAULA",
            "last_name": "VERGARA",
            "middle_name": "VALERIA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.