Organization
WAKE FOREST HEALTH NETWORK LLC
Active
Other names
Atrium Health Wake Forest Baptist Pediatrics - Bermuda Run
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG MICHAEL GREVEN (SR VP CLINICAL OPERATIONS)
(336) 716-1331
Entity
Organization
Contact information
Practice address
114 KINDERTON BLVD, BERMUDA RUN, NC 27006-7302
(336) 998-9742
(336) 998-9410
Mailing address
114 KINDERTON BLVD, BERMUDA RUN, NC 27006-7302
(336) 998-9742
(336) 998-9410
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912346
—
NC
01
—
CB8658
RR MEDICARE
NC
01
—
CC4241
RR MEDICARE
NC
01
—
CC4243
RR MEDICARE
NC
01
—
CD6614
RR MEDICARE
NC
Enumeration date
01/12/2009
Last updated
09/25/2025
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