MEDICARE: WAKE HEART AND VASCULAR ASSOCIATES P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083612394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE HEART AND VASCULAR ASSOCIATES P.A.

Provider Business Mailing Address
First Line	:	300 ASHVILLE AVE
Second Line	:	301
City	:	CARY
State	:	NC
Zip	:	27518-8682
Country	:	US
Telephone Number	:	919-851-6901
Fax Number	:	919-851-9354

Provider Business Practice Location Address
First Line	:	300 ASHVILLE AVE
Second Line	:	301
City	:	CARY
State	:	NC
Zip	:	27518-8682
Country	:	US
Telephone Number	:	919-851-6901
Fax Number	:	919-851-9354

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DEE DARKES
Credential	:
Telephone Number	:	919-420-1342

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/21/2022

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