# WAKEMED SPECIALISTS GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed Obstetrics & Gynecology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063076453
- **Authorized official:** KAREN REVICKI PERRY (SLED)
- **Authorized official phone:** (919) 350-8000

## Contact information

- **Practice address:** 3024 NEW BERN AVE, RALEIGH, NC 27610-1247
- **Practice address phone:** (919) 350-1380
- **Practice address fax:** (919) 556-0124
- **Mailing address:** PO BOX 603949, CHARLOTTE, NC 28260-3949
- **Mailing address phone:** (919) 350-0552
- **Mailing address fax:** (919) 350-7687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VG0400X | Gynecology Physician | — | NULL | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 207VX0000X | Obstetrics Physician | — | NULL | — |
| 207VX0000X | Obstetrics Physician | — | — | — |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 07/23/2025