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General NPI Number Information
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NPI Number | 1538123450
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Entity Type | Organization
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Legal Business Name | WAKE RADIOLOGY DIAGNOSTIC IMAGING, INC.
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 3949 BROWNING PL
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City | RALEIGH
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State | NC
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Zip | 27609-6536
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Country | US
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Telephone | 919-787-8221
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Fax | 919-881-2079
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Provider Business Mailing Address
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Address Line | PO BOX 19368
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City | RALEIGH
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State | NC
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Zip | 27619-9368
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Country | US
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Telephone | 919-787-8221
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Fax | 919-881-2079
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. CHARLES THOMAS WILCOX
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Credential | MBA, MHA
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Telephone | 919-787-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging 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 | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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