Healthcare Provider Details

I. General information

NPI: 1326020611
Provider Name (Legal Business Name): WAKE HEART AND VASCULAR ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W WILLIAMS ST 105-B
APEX NC
27502-3955
US

IV. Provider business mailing address

1031 W WILLIAMS ST 105-B
APEX NC
27502-3955
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-4120
  • Fax: 919-387-4148
Mailing address:
  • Phone: 919-387-4120
  • Fax: 919-387-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DEE DARKES
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-420-1342