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Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Other names
WakeMed H&V Advanced Heart Failure
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
3000 NEW BERN AVE STE 1200, RALEIGH, NC 27610-1231
(919) 350-7600
(919) 350-8333
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
07/19/2017
Last updated
10/25/2017
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