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NPI Code Detail

MEDICARE: WAKE SPECIALTY PHYSICIANS LLC

MEDICARE: WAKE SPECIALTY PHYSICIANS LLC
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
1207R00000XInternal Medicine Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1790420859
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAKE SPECIALTY PHYSICIANS LLC
Provider Business Mailing Address
First Line : PO BOX 602195
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2195
Country : US
Telephone Number : 919-350-0554
Fax Number :
Provider Business Practice Location Address
First Line : 7901 T W ALEXANDER DR
Second Line :
City : RALEIGH
State : NC
Zip : 27617-7211
Country : US
Telephone Number : 919-350-8000
Fax Number :
Authorized Official
Title or Position : VP, WPP
Name : SHONDRA LYNN BRINK
Credential :
Telephone Number : 919-350-6045
Provider Enumeration Date : 05/03/2022
Last Update Date : 05/03/2022

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Directions to “WAKE SPECIALTY PHYSICIANS LLC ” Practice Location

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