MEDICARE: MS. ELITA N WYCKOFF MD

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	207V00000X	Obstetrics & Gynecology Physician	2005 00581	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	:	1629033352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELITA N WYCKOFF MD

Provider Business Mailing Address
First Line	:	550 NEW WAVERLY PL
Second Line	:	SUITE 200
City	:	CARY
State	:	NC
Zip	:	27518-7412
Country	:	US
Telephone Number	:	919-467-5941
Fax Number	:	919-655-0532

Provider Business Practice Location Address
First Line	:	550 NEW WAVERLY PL
Second Line	:	SUITE 200
City	:	CARY
State	:	NC
Zip	:	27518-7412
Country	:	US
Telephone Number	:	919-467-5941
Fax Number	:	919-655-0532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/08/2010

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