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General NPI Number Information
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NPI Number | 1063076453
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Entity Type | Organization
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Legal Business Name | WAKEMED SPECIALISTS GROUP LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 3024 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1247
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Country | US
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Telephone | 919-350-1380
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Fax | 919-556-0124
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Provider Business Mailing Address
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Address Line | PO BOX 603949
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City | CHARLOTTE
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State | NC
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Zip | 28260-3949
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Country | US
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Telephone | 919-350-0552
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Fax | 919-350-7687
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Authorized Official
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Title or Position | SLED
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Name | KAREN REVICKI PERRY
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Credential |
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Telephone | 919-350-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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