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General NPI Number Information
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NPI Number | 1043487036
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Entity Type | Individual
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Provider Name | KENNETH ALAN WOLPERT P.A.-C., C.D.E.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 4551 NEW BERN AVE STE 160
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City | RALEIGH
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State | NC
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Zip | 27610-1552
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Country | US
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Telephone | 919-556-1008
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Fax | 919-556-6099
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Provider Business Mailing Address
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Address Line | PO BOX 61982
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City | DURHAM
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State | NC
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Zip | 27715-1982
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Country | US
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Telephone | 919-961-7394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101773
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License Number State | NC
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