WAKE SPECIALTY PHYSICIANS, LLC (NPI# 1144634270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1144634270 |
Entity Type | Organization |
Organization Name | WAKE SPECIALTY PHYSICIANS, LLC |
Other Organization Name | WAKEMED HEART & VASCULAR PHYSICIANS VASCULAR SURGERY |
Practice Address |
3000 New Bern Ave Raleigh NC 27610-1231 |
Mailing Address |
Po Box 602195 Charlotte NC 28260-2195 |
Practice Telephone | 9193507600 |
Practice Fax Number | 9193508333 |
Mailing Telephone | 9193500554 |
Enumeration Date | 2014-06-17 |
Last Update Date | 2016-09-12 |
Authorized Official Name | MARIA JAYOUSSI (EXECUTIVE DIRECTOR) |
Authorized Official Telephone | 9193500554 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | 1942440375 | 05 |
Other Name | Type Code |
---|---|
WakeMed Heart & Vascular Physicians Vascular Surgery | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588216253 | Wake Specialty Physicians, LLC | Pediatrics | 204 Medspring Dr, Clayton, NC 27520-9293 | 2019-07-12 |
1346722865 | Wake Specialty Physicians, LLC | Orthopaedic Surgery | 120 Healthplex Way Ste 206, Apex, NC 27502-8403 | 2018-08-31 |
1811304678 | Wake Specialty Physicians, LLC | Durable Medical Equipment & Medical Supplies | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2014-07-14 |
1649686577 | Wake Specialty Physicians, LLC | Orthopaedic Surgery | 222 Ashville Ave Ste 20, Cary, NC 27518-6130 | 2014-07-11 |
1659934511 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-04-17 |
1922591049 | Wake Specialty Physicians, LLC | Surgery | 160 Macgregor Pines Dr, Cary, NC 27511-6036 | 2018-06-13 |
1861922775 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2017-06-13 |
1760861678 | Wake Specialty Physicians, LLC | Obstetrics & Gynecology | 10010 Falls of Neuse Rd, Raleigh, NC 27614-8494 | 2015-05-26 |
1619374261 | Wake Specialty Physicians, LLC | Urology | 218 Ashville Ave, Cary, NC 27518-6118 | 2014-11-25 |
1740680222 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2014-09-03 |
Street Address |
3000 NEW BERN AVE |
City | RALEIGH |
State | NC |
Zip Code | 27610-1231 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972508661 | George Rayburn Cheely | Internal Medicine | 3000 New Bern Ave, Ste 1200, Raleigh, NC 27610-1231 | 2005-06-17 |
1811507700 | Erika Barbosa Richard | Registered Nurse | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-08-05 |
1790395846 | Dana Sroka Thomson | Physical Therapist | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-08-04 |
1477163756 | Sarah Anne Schwisow | Registered Nurse | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-08-03 |
1831708486 | Andrew Yoon | Physician Assistant | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-07-29 |
1770104622 | Sonya Zaghloul | Speech-Language Pathologist | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-05-01 |
1871121269 | Bethany Shaffer Flinchum | Clinic/Center | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-03-31 |
1326674789 | Thomas Mellette | Dietitian, Registered | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-03-18 |
1457986234 | Rose Meitzen | Nurse Practitioner | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-03-11 |
1932733847 | Olga Sushkevich | Dietitian, Registered | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-02-29 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609499243 | Elizabeth Ranganai Mavindidze | Social Worker | Wakemed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610 | 2020-05-18 |
1851958839 | Alex & Associates, P.C. | Dentist | 1600 Cross Link Road, Unit 103, Raleigh, NC 27610 | 2019-05-24 |
1639646367 | Carol Mary Medins | Dietitian, Registered | Wakemed Raleigh Medical Park, 23 Sunnybrook Road, Suite 200, Raleigh, NC 27610 | 2018-10-31 |
1144714601 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 123 Sunnybrook Rd Ste 150, Raleigh, NC 27610 | 2018-06-19 |
1417446006 | Eagles Eye Lab, Inc | Clinical Medical Laboratory | 4501 New Bern Ave, Ste: 130, Raleigh, NC 27610 | 2018-05-09 |
1316465206 | Jeffery King Neer | Social Worker | 3010 Falstaff Rd., C/o Unc Actt, Raleigh, NC 27610 | 2017-08-31 |
1083139885 | Kelsey Daniel Mccleave | Social Worker | 3630 Enduring Freedom Drive, Raleigh, NC 27610 | 2017-08-14 |
1891219093 | Tarheel Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4840 Quarryman Road, Raleigh, NC 27610 | 2017-07-29 |
1508214826 | Compassionate Care Providers LLC | Respite Care | 5110 Wetlands, Raleigh, NC 27610 | 2016-05-26 |
1730552530 | Matthew Belair | Pharmacist | 1601-51 Cross Link Rd, Raleigh, NC 27610 | 2015-11-03 |
Find all providers in zip 27610 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104001742 | Raleigh Vein & Laser Center Pa | Surgery | 10000 Falls of Neuse Rd., Suite 303, Raleigh, NC 27614 | 2008-01-02 |
1588602304 | Richard David Edrington | Surgery | 3300 Executive Dr Ste 304, Raleigh, NC 27609-7492 | 2006-06-03 |
1033179122 | Luan Tran | Surgery | 2245 Gateway Access Pt, Suite 315, Raleigh, NC 27607-3077 | 2006-03-24 |
1801450283 | Wakemed Specialists Group, LLC | Surgery | 3713 Benson Dr, Raleigh, NC 27609-7371 | 2019-05-01 |
1811404999 | North Carolina Vascular Specialists, Pa | Surgery | 3713 Benson Dr Ste 202, Raleigh, NC 27609-7372 | 2018-01-10 |
1275876393 | Heather Waldrop | Surgery | 3300 Executive Dr Ste 304, Raleigh, NC 27609-7492 | 2013-03-27 |
1457621765 | Rex Physicians LLC | Surgery | 2800 Blue Ridge Rd, Suite 300, Raleigh, NC 27607-6478 | 2012-01-03 |
1336443712 | Rex Hospital Inc | Surgery | 4414 Lake Boone Trl, Suite 108, Raleigh, NC 27607-7513 | 2010-12-29 |
1053636894 | Liliana Nanez | Surgery | 4414 Lake Boone Trl, Rex Vascular Specialists, Suite 108, Raleigh, NC 27607-7513 | 2010-04-05 |
1376733873 | Jason K Kim | Surgery | 4414 Lake Boone Trl, Raleigh, NC 27607-7513 | 2007-07-31 |
Find all providers in RALEIGH |
Please comment or provide details below to improve the information on WAKE SPECIALTY PHYSICIANS, LLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.