Healthcare Provider Details

I. General information

NPI: 1184703332
Provider Name (Legal Business Name): ROBERT D WADLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 BRIER CREEK PKWY STE 200
RALEIGH NC
27617-7869
US

IV. Provider business mailing address

7780 BRIER CREEK PKWY STE 200
RALEIGH NC
27617-7869
US

V. Phone/Fax

Practice location:
  • Phone: 919-596-3400
  • Fax: 919-596-3499
Mailing address:
  • Phone: 919-596-3400
  • Fax: 919-596-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2006-01698
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: