# WAKE SPECIALTY PHYSICIANS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed Heart & Vascular Physicians Carolina Cardiovascular Surgical A
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346651379
- **Authorized official:** MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE)
- **Authorized official phone:** (919) 350-6089

## Contact information

- **Practice address:** 3000 NEW BERN AVE, RALEIGH, NC 27610-1231
- **Practice address phone:** (919) 231-6333
- **Practice address fax:** (919) 231-6334
- **Mailing address:** PO BOX 602195, CHARLOTTE, NC 28260-2195
- **Mailing address phone:** (919) 350-0552
- **Mailing address fax:** (919) 350-7687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | — | NC | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2014
- **Last updated:** 09/12/2016