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Organization
WAKEMED SPECIALISTS GROUP LLC
Active
Organization
WAKEMED SPECIALISTS GROUP LLC
Active
Other names
WakeMed Childrens Special Infant Care
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN REVICKI PERRY (SLED)
(919) 350-8000
Entity
Organization
Contact information
Practice address
3024 NEW BERN AVE, RALEIGH, NC 27610-1247
(919) 350-7846
(919) 350-8147
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790343366
—
NC
Enumeration date
05/30/2019
Last updated
07/23/2025
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