Mary L Wisniewski, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2010-01227 Issued in NC

Practice address

118 Memorial Dr
Jacksonville, NC 28546-6328

Phone

(910) 353-0581

Fax

(910) 577-1150

NPI assigned

Jun 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacksonville Children'S and Multispecialty Clinic, PA

  • Family Medicine Physician
  • Jacksonville, NC
  • NPI 1164519070

  Pediatrics

  Medicare reassignment NPD
• Amm Healthcare, PA

  • Family Medicine Physician
  • Cary, NC
  • NPI 1528639689

  Pediatrics

  NPD
• Jacksonville Behavior and Mental Health

  • Adolescent and Children Mental Health Clinic/Center
  • Jacksonville, NC
  • NPI 1770771750
  NPD
• Family Care Clinic, P.a.

  • Clinic/Center
  • Jacksonville, NC
  • NPI 1316033590
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1548201890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986513",
            "address_2": "DEPARTMENT 100",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022986513",
            "telephone_number": "910-219-8326",
            "fax_number": "910-939-4269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MEMORIAL DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466328",
            "telephone_number": "910-353-0581",
            "fax_number": "910-577-1150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285466328",
            "country_code": "US",
            "telephone_number": "910-353-0581",
            "fax_number": "910-353-1351",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 Lakeside Dr",
            "address_purpose": "LOCATION",
            "city": "Sneads Ferry",
            "state": "NC",
            "postal_code": "284609415",
            "country_code": "US",
            "telephone_number": "910-327-5437",
            "fax_number": "910-327-5436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "MARY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2010-01227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Winebrenner, PT, DPT
• Perry Winford, FNP-BC
• David Brice Wisdom, MSPT
• Karolina Wise, AGACNP-BC
• Brooke Wiseman, RDN
• Without Limits Counseling Services PLLC
• Jessica Wittmann
• Stephanie Wodowski, D.O.
• Gregory Michael Wohlgemuth, DMD
• Nicole Wojcik, LPCA

• Pediatrics Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.